Conclusion: SSR events are associated with a high burden of injury and occasionally fatality and expense to hospitals.Strict regulation regarding safety is essential as is improved safety provisions for spectators. Aim: The NHS uses a number of indices to assess quality and safety. One measure is the RAMI, which adjusts risk for individual patient risk factors/co-morbidities. RAMI accuracy is highly dependent on quality of clinical coding and as a result its value has been questioned. Use of

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... OSSUM prior to surgery is now commonplace and provides a prospective, physiological predictor of risk. We compared the correlation of RAMI with P-POSSUM scoring among surgical in-hospital mortalities. Methods: We analysed 35 cases of post-operative, in-hospital mortality from both elective and emergency surgery during 2013. Variables assessed included age, gender, duration of admission and type of surgery, along with pre-operative P-POSSUM score and the RAMI score obtained following death. Results: Median patient age was 71 (45e89) and 57% (n ¼ 20) were female. Median in-hospital stay was 4 days (1e30) and 69% (n ¼ 24) underwent emergency rather than elective surgery. Median P-POSSUM and RAMI scores were 30.3% (0.71e96.70%) and 25.3% (0.50e99.40%)respectively with correlated poorly (a ¼ 0.04, p ¼ ns) for both elective and emergency surgery. Conclusion: RAMI and P-POSSUM scores correlated poorly while there was a trend towards higher P-POSSUM scores within our cohort. The validity of RAMI remains in question and further large scale comparative work is indicated.