Measuring outcomes after major abdominal surgery during hospitalization: reliability and validity of the Postoperative Morbidity Survey

Simon J Davies, James Francis, Jonathan Dilley, R Jonathan T Wilson, Simon J Howell, Victoria Allgar, Simon J Davies, James Francis, Jonathan Dilley, R Jonathan T Wilson, Simon J Howell, Victoria Allgar

Abstract

Background: Measurement of outcomes after major abdominal surgery has traditionally focused on mortality, however the low incidence in elective surgery makes this measure a poor comparator. The Postoperative Morbidity Survey (POMS) prospectively assesses short-term morbidity, and may have clinical utility both as a core outcome measure in clinical trials and quality of care. The POMS has been shown to be a valid outcome measure in a mixed surgical population, however it has not been studied in patients undergoing major abdominal surgery. This study assessed the inter-rater reliability and validity of the POMS in patients undergoing major abdominal surgery.

Methods: Patients undergoing elective major abdominal surgery were visited on postoperative day 1 until discharge by two novice observers who administered the POMS in order to assess inter-rater reliability. Subjects who had previously had the POMS performed prospectively on postoperative days 3 and 5 were identified from a database. The pattern and prevalence of morbidity was analyzed against hospital length of stay (LOS) in order to validate the POMS in this patient group.

Results: Fifty one patients were recruited to the inter-rater reliability study giving a total of 263 POMS assessments. Inter-rater reliability showed a 97.7% agreement with a κ coefficient of 0.912 (95% CI: 0.842 to 0.982). On domain analysis percentage agreement was lowest in the gastrointestinal domain (87.5%), whilst correlation was lowest in the wound (κ: 0.04; 95% CI: -1.0 to 1.0) and hematological domains (κ: 0.378; 95% CI: 0.035 to 0.722). All other domains showed at least substantial agreement. POMS assessments were analyzed for postoperative days 3 (n = 258) and 5 (n = 362). The absence or presence of morbidity as measured by the POMS was associated with a hospital LOS of 6 (IQR: 4 to 7) vs. 11 (IQR: 8 to 15) days on postoperative day 3 (P <0.0001), and 7 (IQR: 6 to 10) vs. 13 (IQR: 9 to 19) days on postoperative day 5 (P <0.0001). The presence of any morbidity on postoperative day 5 conferred an odds ratio for a prolonged hospital LOS of 11.9 (95% CI: 5.02 to 11.92).

Conclusions: This study shows that the POMS is both a reliable and valid measure of short-term postoperative morbidity in patients undergoing major abdominal surgery.

Figures

Figure 1
Figure 1
Kaplan-Meier curves for hospital LOS based upon the presence or absence of POMS defined morbidity on postoperative days 3 and 5.
Figure 2
Figure 2
Hospital LOS for the presence or absence of morbidity by individual POMS domain type on postoperative day 3. Data is reported as median with interquartile range.
Figure 3
Figure 3
Hospital LOS for the presence or absence of morbidity by individual POMS domain type on postoperative day 5. Data is reported as median with interquartile range.

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