The Interest of Validation of the Predictive Mortality Score in Heavy Digestive Surgery in Algeria

The search for quality indictors is a constant concern of medical activity.In surgery, multi-variate analyses of mortality which is a simple indicator of quality, is bringing more to the mainstream two other independent factors; patient age and comorbidity. So centres with high patient turnover have a significant recruitment bias towards young patients with lesser comorbidity. To illustrate this concept we have taken surgical mortality rates of patients operated for ulcerative-hemmorragic-recto-colitis in the CHU of Algiers over two time frames ; A (2001-2006) and B (2007-2012). "Good health sense" permits the conclusion that the operative mortality rates in time frame B is lesser than that of time period A. In fact, the patients in period B are significantly younger, with less serious illness and less affected than those in period A and « good scientific sense » does not permit any conclusion of superior performance in period B over period A. We observed similar findings after surgery of the pancreas and the rectum. This is why it is essential to compare rates using a predictive score which is validated and provides numerical assessment. The POSSUM score, validated since 1991 has been used in our study as has similarly been used in France by the research association FRENCH.In the current situation in Algeria, the use of this score is obligatory in any evaluation of the quality of care provided and selection of expert centres.