Comparison between POSSUM and P-POSSUM Scores in Prediction of Post-Operative Mortality and Morbidity in Patients Undergoing Emergency Laparotomy at Omdurman Teaching Hospital
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2015, Vol 3, Issue 2
Abstract
Comparison of operative morbidity rates after emergency laparotomy between units may be misleading because it does not take into account the physiological variables of patients’ conditions. Surgical risk scores have been created and the most commonly used is, the Physiological and Operative Severity Score for the enUmeration of Mortality (POSSUM) or one of its modifications the Portsmouth-POSSUM (P-POSSUM), usually require intra-operative information. The Objective is to evaluate the POSSUM and P-POSSUM scores in predicting post-operative morbidity and mortality in patients undergoing emergency laparotomy. This is a prospective, cross-sectional and hospital-based study that was conducted at Omdurman Teaching Hospital from Mar. 2013 - Mar.2014. Included were adult patients who presented at the causality and underwent emergency laparotomy. Observed and predicted mortality and morbidity were calculated using POSSUM and P-POSSUM equations and statistical significance was calculated using cui square test. A total of 119 patients were included in this study, with a mean age of 22.4±17.4 years. The Observed (O) mortality was 17 (14.3%), while POSSUM predicted 37 (31%), and P-POSSUM 27 (22.6). The O/E ratio for POSSUM was 0.46 and for P-POSSUM was 0.63 and this mean that they both over-estimate mortality. When the results were tested by chi square test, the P value was found to be 0.738 and 0.479, for POSSUM and P-POSSUM respectively and P-POSSUM respectively, which showed no significant correlation for observed and expected mortality. The Observed morbidity was 34(28.8%), while POSSUM expected morbidity was 80(67.2%), O/E ratio is 0.43 and this again over-estimate the morbidity. POSSUM is over-predicting the rate of morbidity and test of correlation showed no significance with P value of 0.656.In conclusion, POSSUM and P-POSSUM were found to be over estimate mortality and morbidity in patients undergoing emergency laparotomy, and it cannot be used in surgical audit. Keywords: POSSUM and P-POSSUM, Physiological score, Operative score, Observed morbidity, Predicted morbidity, Observed mortality, Predicted mortality.
Authors and Affiliations
Sarah Mohammed Ahmed Yosif, Aamir Abdullahi Hamza, Seif Ibrahim Mahadi
Keywords
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