Physiological POSSUM as an indicator for long-term survival in vascular surgery

Objectives: We investigated whether the POSSUM physiology score, originally designed as an indicator for 30-day mortality for comparative audit, could be used as an indicator of long-term survival in vascular surgery practice. Methods: Data from 184 different vascular procedures conducted between 1989 and 2000, containing survival data for each patient of 10 years or longer, were analysed retrospectively. Parameters collected were the pre-operative physiological and the operative severity POSSUM score, gender, and type of procedure. Multivariate analyses were performed using Cox regression method and, on the basis of their physiological POSSUM score grouping, Kaplan-Meier analysis was performed for estimation of overall survival. Results: Both an increase in physiological POSSUM score (hazard ratio [HR] 1.050, 95% confidence interval [CI] 1.031 to 1.070) and one of its components, age (HR 1.025, 95% CI 1.006 to 1.045; p = 0.009), were shown to be indicators of long-term all-cause mortality. The sample's mean physiological POSSUM score of 21 was then used as a cut-off point to categorise low and high-risk vascular surgery patients. Median survival in the low-risk group was 70 months (95% CI 56-86 months), whereas in the high-risk group this was 17 months (95% CI 3-31 months). Conclusion: The physiological POSSUM score, including patient age, is an indicator of long-term survival of patients with vascular disease. This may help in choosing the appropriate vascular intervention.