Publication:

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

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.