THE USE OF POSSUM AND SURGICAL RISK SCORE (SRS) IN PREDICTING HIP FRACTURES NEEDING EARLY SURGERY TO IMPROVE OUTCOMES. CAN WE DO BETTER?

Abstract

We present the use of the Orthopaedic POSSUM Score and Surgical Risk Score (SRS) to identify optimal time for fracture neck of femur surgery. The objective of this study was to identify the physiological status of patients at admission and compare the results of operative physiological condition and differences in predictive and actual operative outcomes.

1238 consecutive hip fractures from Jan 2005 to July 2006 at 3 hospitals were assessed. Collection of demographic, admission and operative POSSUM, and SRS scores, fracture pathology, physiological status, and postoperative outcome were conducted.

In total, 1031 (83.3%) patients had surgery. The median age was 72.6 (range 55–95, mean 68). Majority had significant systemic multiple co-morbidity (78%), an average ASA score of 3.3. POSSUM predicted 18.7% (n= 194) of death at 30 days, where as the surgical risk score predicted 13.8% (n=142 deaths), the actual mortality was 11.7% (n=120).

The difference between admission and operative physiological POSSUM score increased with operative delay (see table 1). Physiological scores greater than 30 had a 67.8% risk of 30-day mortality. 361 patients had an increase in physiological score from admission to operation, resulting in higher analgesic requirements and reduced mobility scores (P< 0.005). These patients had a 12.6% increase in mortality when compared with patients operated earlier with a similar initial score (P< 0.005). Furthermore delayed surgery (> 48 hours) lead to reduced in return mobility, function, increased wound infections and other medical complications.

Possum and SRS over predict operative mortality, but are useful in prioritising their time of surgery. Declining operative physiological POSSUM scores indicate room for improvement in preoperative care, and for specific protocols if surgery has to be delayed to prevent further physiological deterioration, and induce optimal functional outcomes.