Evaluation of Clinical Outcome of Patients Undergoing Emergency Laparotomy with the Help of Portsmouth Predictor Equation for Mortality (P-Possum Score)

Abstract

Introduction: Emergency laparotomy, though lifesaving, may result in significant morbidity and mortality. In an attempt to clinically evaluate patients undergoing emergency laparotomy and predict their mortality using the worldwide accepted Portsmouth Predictor equation for mortality (P POSSUM), the present study was undertaken in the Surgery department of a tertiary care hospital in eastern India. Material and methods: This observational cross-sectional study included 60 patients aged between 15 to 75 years, undergoing emergency laparotomy during the specified study period of one and half years. Results: It was observed that out of 60 patients, 63.3% were male, and mean age was 40.60 (16.67) years. Peptic perforation was the most common indication for laparotomy. Mean P POSSUM predicted mortality risk was 40.617% (Range-0.8 to 99.7). Twenty-four patients died during hospital stay. ROC curve analysis of P POSSUM scores revealed that if a cut off value of P POSSUM score of 42.45% was selected, mortality could be predicted with a sensitivity of 70.80% and a specificity of 83.30%. Conclusion: Thus, P POSSUM might be a useful tool in predicting risk of short-term mortality following emergency laparotomy.

Use of POSSUM (Physiologic and Operative Severity Score for the Study of Mortality and Morbidity) and Portsmouth-POSSUM for Surgical Assessment in Patients Undergoing Emergency Abdominal Surgeries

“…Similar scores were reported by other studies in other parts of the world [ 7 , 29 , 30 ]. A study by Dilip Kumar Das et al [ 9 ] recorded that the operative severity score (p = 0.017) was significantly associated with mortality in the study population. Operative scores in P-POSSUM had a greater effect on the mortality rate than the operative scores of POSSUM.…”

“…In a study by Avinash Vishwani et al [ 5 ], 25.8% belonged to the age group 21-30, followed by 19.1% in the age group 51-60 years. A study by Dilip Kumar Das et al [ 9 ] reported the average age of the study participants as 40.6 ± 16.67. The mean age was 75.4 ± 7.3 years in a study by Yang Cao et al [ 25 ].…”

“…It has already been used in general, colorectal, vascular, esophageal, and laparoscopic procedures, but the studies have mostly involved patients in developed countries, where the characteristics and presentation of patients and available resources differ from developing countries [9].…”

“…It has the same grading system and variables, but a different equation, providing a better fit to the observed mortality rate, which is an objective measure of the outcome. It has already been used in general, colorectal, vascular, esophageal, and laparoscopic procedures, but the studies have mostly involved patients in developed countries, where the characteristics and presentation of patients and available resources differ from developing countries [ 9 ].…”