A prospective study of risk stratification in patients undergoing emergency laparotomy with POSSUM and P-POSSUM


  • Ajay Kumar Jain Department of Surgery, PCMS & RC, Bhopal, MP, India
  • Dhiraj Sharma Department of Surgery, PCMS & RC, Bhopal, MP, India




POSSUM, P-POSSUM, Morbidity, Emergency laparotomy


Background: Physiological and operative severity score for enumeration of mortality and morbidity (POSSUM) and its Portsmouth modification (P-POSSUM) have been developed and validated in many studies to assess the risk of mortality and morbidity associated with the various surgical procedures. Prediction of risk of mortality and morbidity involved in a surgical procedure not only helps clinicians in adequate preparation but also patient counselling.

Methods: One hundred and seven consecutive patients who underwent emergency laparotomy in the year 2009 at our center were studied. Mortality and Morbidity risk were calculated in each using POSSUM and P-POSSUM. The ratio of observed to predicted death and morbidity (0: E) were calculated and compared using chi square test. Serum creatinine level and delay in presentation to hospital were also noted in each as adjuncts variables.

Results: POSSUM was found to over predict both mortality and morbidity (O: E = 0.44 and 0.66 respectively). P-POSSUM accurately predicted mortality (O: E =0.98). Both POSSUM and P-POSSUM over predicted mortality in low risk groups (predicted risk of mortality <20%, O: E= 0.00 and 0.34 respectively). Average serum creatinine levels and delay in presentation to hospital among patients who survived and those who expired were 1.67 & 2.42 mg/dl and 2.04 & 2.89 days respectively.

Conclusions: Although both equations are useful tools for risk-adjusted surgical audit of patients undergoing emergency laparotomy, P-POSSUM is a better predictor of mortality than POSSUM. Overall, morbidity and mortality risk were found to be significantly higher with delayed hospital presentation and deranged creatinine levels.


GP Copeland. The POSSUM System of Surgical Audit. Arch Surg. 2002;137:15-9.

Edward AE, Seymour DG, McCarthy JM, Crumplin MKH. A 5 year survival study of general surgical patients aged 65 or over. Anaesthesia. 1996;51:3-10.

Horsham P, N’guyen-Van-Tam JM, Letoquart JP, Pompilio M, HaffafY, Chaperone J, et al. Predictive factor of morbidity and mortality in coelectomy patients over 75 years of age. Journal Chirgurie Paris. 1990;127:392-5.

Copeland GP, Jones D, Walters M. POSSUM a scoring system for surgical audit. Br J Surg. 1991;78:355-60.

Jones HJ, de Cossart L. Risk scoring in surgical patients. Br J Surg. 1999;86:149-57.

Whiteley MS, Prytherch DR, Higgins B, Weaver PC, Prout WG. An evaluation of the POSSUM surgical scoring system Br J Surg. 1996;83:812-5.

Leteurte S. Can generic pediatric mortality scores calculated 4 hours after admission be used as inclusion criteria for clinical trials? Critical care. 2004;8.

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

Tekkis PP, Kocher HM, Bentley AJ, Cullen PT, South LM, Trotter GA. Operative mortality rates among surgeons: Comparison of POSSUM and p-POSSUM scoring systems in gastrointestinal surgery. Dis Colon Rectum. 2000;43:1528-32.

Wijesinghe LD, Mahmood T, Scott DJA, Berrodge DC, Kent PJ, Kester FC. POSSUM and the Portsmouth predictor equation for predicting death following vascular surgery. Br J Surg. 1998;85:209-12.

Midwinter MJ, Tytherleigh M, Ashley S. Estimation of mortality and morbidity risk in vascular surgery using POSSUM and the Portsmouth predictor equation. Br J Surg. 1999;86:471-4.

Prytherch DR, Suttor BL, Boyel JR. Portsmouth POSSUM model for abdominal aortic aneurysm surgery. Br J Surg. 2001;88:958.

Mohil RS, Bhatnagar D, Bahadur L, Rajneesh, 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.

Kumar P, Rodrigues GS. Comparison of POSSUM and P-POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy. Dig Surg. 2009;26(1):75-9.






Original Research Articles