Evaluation of O-POSSUM in predicting in-hospital mortality after resection for oesophageal cancer

Background: The aims of the present study were to validate the Physiological and Operative Severity Score for the enUmeration of Mortality adjusted for oesophagogastric surgery (O‐POSSUM). Methods: Data on patients who underwent potentially curative oesophagectomy in a tertiary referral centre for adenocarcinoma or squamous cell carcinoma of the oesophagus were analysed. The in‐hospital mortality predicted by O‐POSSUM was compared with the actual value by linear analysis. Results: Twenty‐four (3·6 per cent) of 663 patients died in hospital. The observed : predicted ratio for in‐hospital mortality was 0·29. The model had a poor fit (P < 0·001). The area under the receiver–operator characteristic curve was 0·60 (95 per cent confidence interval 0·47 to 0·72); P = 0·113). O‐POSSUM score was not related to the severity of complications. Conclusion: O‐POSSUM overpredicted in‐hospital mortality threefold and could not identify patients at higher risk of death. O‐POSSUM needs substantial modification before it can be used for comparison of treatment outcomes between centres. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. No value for comparative audits