Mortality control charts: Both components of POSSUM ratio require critical analysis

doi:10.1136/bmj.326.7403.1397-a

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George A Khoury, consultant surgeon (shw000@msn.com)

Conquest Hospital, East Sussex NHS Trust, St Leonards on Sea, TN37 7RD

EDITOR—Mean mortality of almost 10% and 30% (max 50%) is reported for elective and emergency gastro-oesophageal surgery in 29 units.1 Yet none had underperformed. A benchmark is set even though institutions were not randomised.

A multifactorial model is created by using POSSUM to fit this dataset.2 POSSUM's overpredicting tendency …