Efficacy of the P-POSSUM scoring system as a prognostic indicator in patients undergoing emergency laparotomy

Authors

  • Karthic Anbarasu Department of Surgery, RNT Medical College, Udaipur, Rajasthan, India http://orcid.org/0000-0001-5999-7616
  • Rohit Chandak Department of Surgery, RNT Medical College, Udaipur, Rajasthan, India

DOI:

https://doi.org/10.18203/2349-2902.isj20194411

Keywords:

P-POSSUM, Observed expected ratio, Prognostic indicator, Emergency laparotomy

Abstract

Background: Continuous audit of surgical practice is essential in enhancing patient care and lowering health care cost. This prospective study aimed to assess the validity of the Portsmouth- physiologic and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) score in predicting the risk of morbidity and mortality and to identify the risk factors for poor outcome at a tertiary care teaching hospital in India.

Methods: A prospective study of 100 patients (70 emergency and 30 elective) undergoing exploratory laparotomy admitted in Department of General Surgery over a 10 months period at Rabindranath Tagore Medical College, Udaipur, Rajasthan, were included in the study group. The risks of mortality and morbidity were calculated by using P-POSSUM equation. The predicted risks were compared with the observed risks of mortality and morbidity and statistically analysed.

Results: The overall mortality rate of 11% with (O:E=0.85, p=0.59) and morbidity rate of 41% with (O:E=0.78, p=0.089). Higher percentage of mortality and morbidity were found with patients not able to be resuscitated successfully before surgery. Chest infections (18%), pyrexia (15%) and wound infections (14%) are areas requiring prompt care to minimize mortality rate.

Conclusions: Even though P-POSSUM over predicted mortality it was not statistically significant as concluded by other studies. With P-POSSUM outcome of the patient and operative risk can be predicted and pre-operative counselling, optimization, implementing resuscitative measures and adequate care in specific high risk groups can be given with targeted interventions; improving quality of care and cost reduction. 

References

Davidson, Schneider HJ. Audit. Clinical surgery in general 4th Ed. Author Kirk RM. Publisher Churchill Livingstone; 2004: 428-435.

Surgical audit and peer review: A guide by Royal Australasian College of surgeons, 3rd edition, 2008: 3-4.

Copeland GP, Jones D, Wilcox A, Harris PL. Comparative vascular audit using the POSSUM scoring system. Ann R Coll Surg Engl. 1993;75(3):175.

Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ. POSSUM and Portsmouth POSSUM for predicting mortality. Br J Surg. 1998;85(9):1217-20.

Sagar PM, Harley MN, Mancey Jones B, Sedman PC, May J. Comparative audit of colorectal resection with the POSSUM scoring system. Br J Surg. 1994;81(10):1492-94.

Tekkis PP, Kocher HM, Bentley AJ. Operative mortality rates among surgeons: comparison of POSSUM and p-POSSUM scoring systems in gastrointestinal surgery. Diseases of the Colon and Rectum. 2000;43(11):1528-32.

Brooks MJ, Sutton R, Sarin S. Comparison of surgical risk score, POSSUM and P-POSSUM in higher-risk surgical patients. BJS. 2005;92:1288-92.

Wakabayashi, Sano, Yachida, Okano. Validation of risk assessment scoring systems for an audit of elective surgery for gastrointestinal cancer in elderly patients: An audit. Int J Surg. 2007;5(5):323-7.

Mohil RS, Bhatnagar D, Bahadur L, Dev DK, Magan M. POSSUM and P-POSSUM for risk‐ adjusted audit of patients undergoing emergency laparotomy. Br J Surg. 2004;91(4):500-3.

Parihar V, Sharma D, Kohli R. Risk adjustment for audit of low risk general surgical patients by Jabalpur-POSSUM score. Indian J Surg. 2005;67(1):38-42.

The higher risk general surgical patient towards improved care for a forgotten group. The Royal College of Surgeons of England and Department of Health. Royal College of Surgery England, London 2011. Available at: www.rcseng.ac.uk/publications/ docs/higher-risk-surgical-patient/. Accessed on 3 June 2019.

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Published

2019-09-26

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Original Research Articles