Efficacy of Possum Score in Predicting the Outcome in Patients Undergoing Emergency Laparotomy
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Monitoring of surgical outcome is increasingly important part of governance of surgical activity. The aim of the study. POSSUM scoring system was applied prospectively to determine how it performed in predicting morbidity and mortality in patients undergoing emergency laparotomy in our hospital, a group known to be at high risk of complications and death. Material and methods. A total of 100 cases of emergency laparotomies were studied in patients admitted in general surgery department during the period of May 2008 to August 2010. The study group consisted of the following cases. Duodenal perforation (37 cases), intestinal obstruction (27 cases), gastric perforation (8 cases), ileal perforation (8 cases), appendicular perforation (7 cases), blunt trauma (4 cases) and others (9 cases). They were scored using POSSUM scoring system. Physiological scoring was done at the time of admission and operative scoring was done intraoperatively. They were followed up for the first 30 day post operative period for any complications and the outcome was noted. The observed morbidity and mortality rates were compared with the POSSUM predicted morbidity and mortality rates. Results. 15 patients died (mortality rate of 15%). The POSSUM predicted mortality was 20 deaths. O:E ratio of 0.71 was obtained. There was no statistically significant difference between the observed and predicted mortality rates (χ2=1.72, p=0.974). 71 patients experienced complications. The POSSUM predicted morbidity was 61 patients. O:E ratio of 1.19 was obtained. There was no statistically significant difference between the observed and predicted morbidity rates (χ2=1.594, p=0.991). Conclusions. POSSUM scoring is an accurate predictor of mortality and morbidity following emergency laparotomy and is a valid means of assessing adequacy of care provided to the patient. POSSUM can be used for surgical audit to assess and improve the quality of surgical care and helps in better outcome to the patient
1 - 4 - 2014
25 - 2 - 2014
27 - 6 - 2014
- Department of Urology, SMS Medical College, Jaipur, India
- Department of General Surgery, Kasturba medical college, Mangalore, India
- Department of General Surgery, MVJ Medical College, Bangalore
- Vijaynagar Institute of Medical Sciences, Bellary
- 1. Sagar PM, Harley MN, Mancey-Jones B et al.: Comparative audit of colorectal resection with the POSSUM scoring system. Br J Surg 1994; 81: 1492-94.[PubMed]
- 2. Copeland GP, Jones DR, Wilcox A et al.: Comparative vascular audit using the POSSUM scoring system. Ann R Coll Surg Engl 1993; 75: 175-77.
- 3. Murray GD, Hayes C, Fowler S et al.: Presentation of comparative audit data. Br J Surg 1995; 82: 329-33.[PubMed]
- 4. Jones HJ de Cossart L: Risk scoring in surgical patients. Br J Surg 1999; 86: 149-157.
- 5. Mohil RS, Bhatnagar D, Bahadur L et al.: POSSUM and P- POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy. Br J Surg 2004; 91: 500-03.[PubMed]
- 6. Copeland GP, Jones D, Walters M: POSSUM: a scoring system for surgical audit. Br J Surg 1991; 78: 355-60.[PubMed]
- 7. Copeland GP: Comparativeaudit: fact versus fantasy. Br J Surg 1993; 80: 1424-1425.[WoS][PubMed]
- 8. Prytherch DR, Whiteley MS, Higgins B et al.: POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enumeration of mortality and morbidity. Br J Surg 1998;85:1217-20.[WoS][PubMed]
- 9. Sagar PM, Hartley MN, MacFie J et al.: Comparison of individual surgeon’s performance. Riskadjusted analysis with POSSUM scoring system. Distal Colon Rectum 1996; 39: 654-58.
- 10. Tekkis PP, Kocher HM, Bentley AJ et al Operative mortality rates among surgeons: comparison of POSSUM and P-POSSUM scoring systems in gastrointestinal surgery. Dis Colon Rectum 2000; 43: 1528-32.[PubMed]
- 11. Yii MK, Ng KJ: Risk-adjusted surgical audit with the POSSUM scoring system in a developing country. Br J Surg 2002; 89: 110-13.
- 12. Mohil RS, Bhatnagar D, Bahadur L et al.,. POSSUM and P- POSSUM for risk-adjusted audit of patients undergoing emergency laparotomy. Br J Surg 2004; 91: 500-03.[PubMed]
- 13. Copeland GP: The POSSUM system of surgical audit. Arch Surg 2002; 137: 15-19.
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