Assessment of surgical outcome in emergency gastrointestinal surgeries using P-POSSUM score

Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and its modification, Portsmouth-POSSUM (P-POSSUM), are considered as methods of risk scoring. Application of this scoring system helps in assessing the quality of the health care provided and surgical outcome. Its utilization in our country where the level of healthcare and resources differ is limited. Hence, a prospective study to assess the outcome of emergency GI surgeries using P-POSSUM scoring system in a teaching hospital at district level was taken up.Methods: 80 cases which underwent emergency GI surgeries were studied. Using P-POSSUM equation, predicted mortality and morbidity rates were calculated and compared with the actual outcome. Statistical significance was calculated using chi square test.Results: An observed to expected ratio of 0.71 and 0.60 was obtained for mortality and morbidity respectively. No significant difference was noted between expected to observed mortality and morbidity rates with P=0.23 and P=0.09 for mortality and morbidity respectively, suggesting a reasonably good quality of outcome. P-POSSUM over predicted mortality and morbidity in low risk groups while it accurately predicted the outcome in high risk groups.Conclusions: The quality of surgical care provided and surgical outcome are comparable to other health care systems, with observed to expected mortality and morbidity ratio being nearly same. P-POSSUM can be used as a tool for outcome audits.

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Evaluation of the validity of POSSUM and P-POSSUM score in predicting the risk of morbidity and mortality respectively in patients undergoing emergency laparotomy

International Surgery Journal ◽

10.18203/2349-2902.isj20203968 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3224

Author(s):

Vivian Anandith Paul ◽

Agnigundala Anusha ◽

Alluru Sarath Chandra

Keyword(s):

Mortality Rate ◽

Linear Method ◽

Morbidity And Mortality ◽

Emergency Laparotomy ◽

Medical Sciences ◽

Mortality And Morbidity ◽

Possum Score ◽

Operative Severity Score ◽

Significant Difference ◽

Predicted Values

Background: Aim of this study is to examine the efficacy of Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth predictor modification (P-POSSUM) equations in predicting morbidity and mortality in patients undergoing emergency laparotomy, to study the morbidity and mortality patterns in patients undergoing emergency laparotomy at Malla Reddy Institute of Medical Sciences, Hyderabad. Methods: The study was conducted for a period of 2 years from February 2018 to February 2020. 100 Patients undergoing emergency laparotomy were studied in the Department of General surgery MRIMS, Hyderabad. POSSUM and P-POSSUM scores are used to predict mortality and morbidity. The ratio of observed to expected deaths (O:E ratio) was calculated for each analysis. Results: The study included total 100 patients, 83 men and 17 women. Observed mortality rate was compared to mortality rate with POSSUM, the O:E ratio was 0.62, and there was no significant difference between the observed and predicted values (χ²=10.79, 9 degree of freedom (df) p=0.148). Observed morbidity rates were compared to morbidity rates predicted by POSSUM, there was no significant difference between the observed and predicted values (χ²=9.89, 9 df, p=0.195) and the overall O:E ratio was 0.91. P-POSSUM predicted mortality equally well when the linear method of analysis was used, with an O:E ratio of 0.65 and no significant difference between the observed and predicted values (χ²= 5.33, 9 df, p= 0.617).Conclusion: POSSUM and P-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.

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Efficacy of the P-POSSUM scoring system in prediction of post-operative mortality and morbidity in patients undergoing emergency laparotomy in a tertiary institute

International Surgery Journal ◽

10.18203/2349-2902.isj20182766 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2523 ◽

Cited By ~ 2

Author(s):

Sivakumar Thirunavukkarasu ◽

Atreya M. Subramanian

Keyword(s):

Scoring System ◽

P Value ◽

Emergency Laparotomy ◽

Accurate Predictor ◽

Mortality And Morbidity ◽

South Indian ◽

Possum Score ◽

Operative Severity Score ◽

Indian Setting ◽

A Prospective Study

Background: The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system and its modification P-POSSUM (Portsmouth-POSSUM) has been studied in various clinical settings, with varied results. Due to its simplicity and wide application, the efficacy must be verified in individual settings. We wish to assess the system’s efficacy among emergency laparotomies in a south Indian clinical scenario.Methods: A prospective study was undertaken with a sample size of 50. All cases taken for emergency laparotomy were included. 12 physiological and 6 intra-operative characteristics were taken and according to the equation the predicted rates of mortality and morbidity were predicted. This was compared with the observed rates. With these results, the efficacy of the scoring system was assessed.Results: Of the 50 cases included 5 expired (10%) and 29 (58%) experienced some form of morbidity. The P-POSSUM score was found to be an accurate predictor of mortality (x2 =1.174, d.f=8) with a p-value of 0.997. The POSSUM score was not found to be an accurate predictor of morbidity (x2 =16.949, d.f=8) with a p-value of 0.0403, as the p-value was <0.05.Conclusions: The P-POSSUM scoring system produced accurate results even in the setting of emergency laparotomies in a south Indian setting. It has proved to be a useful tool for predicting mortality, though not completely accurate to assess post-operative morbidity (POSSUM) due to post-operative factors playing a major role in its determination.

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Evaluation of P- POSSUM Scoring System in Patients Undergoing Emergency Laparotomy

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v16i2.17714 ◽

2017 ◽

Vol 16 (2) ◽

pp. 28-36

Author(s):

Manoj Kumar Jha ◽

Yahun Chandra Sibakoti ◽

Harihar Devkota

Keyword(s):

Risk Factors ◽

Mortality Rate ◽

Prospective Study ◽

Scoring System ◽

Emergency Laparotomy ◽

Mortality And Morbidity ◽

Operative Severity Score ◽

Significant Difference ◽

One Year ◽

Operative Findings

Introduction: The Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) and its modification the Portsmouth POSSUM (P-POSSUM), have been proposed as a method for standardizing patient data so that direct comparisons can be made despite differing patterns of referral and population. In this prospective study, the validity of P-POSSUM was tested in patients undergoing emergency laparotomy and the risk factors for low outcome were noted.Methods: This is the Prospective Study and was conducted in Department of surgery, of a tertiary level hospital. The study period was from April 2014- April 2015 for one year. Patients admitted under department of general surgery scheduled to undergo emergency laparotomy were included and scored according to their physiological and operative findings using a proforma sheet. Physiological scoring was performed just before surgery and operative scoring was carried out intra-operatively. Patients were followed-up for the first 30 days postoperative period. The observed mortality rate was compared with the P-POSSUM predicted mortality rate. Data analysis was done using SPSS 20.Results: A total of 60 patients who met the inclusion criteria were included in this study. On applying linear analysis, an observed to expected ratio of 1.18 was obtained, indicating a significant fit for predicting the post-operative adverse outcome. There was no significant difference between the observed and predicted mortality rates (x2 = 1.467, 4 df., P = 0.833). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and higher POSSUM scores.Conclusion: Portsmouth POSSUM scoring system serves as a good predictor of post-operative outcome in emergency laparotomy procedures.

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Perioperative Mortality Prediction Using Possum in Patients with Gastrointestinal Tumors: Do Immunological Variables Affect Individual Predictive Mortality Risk?

Pteridines ◽

10.1515/pteridines-2018-0012 ◽

2018 ◽

Vol 29 (1) ◽

pp. 114-123

Author(s):

Atilla Engin ◽

Ayse Basak Engin ◽

Osman Kurukahvecioglu ◽

Aylin Sepici-Dincel

Keyword(s):

Mortality Risk ◽

Scoring System ◽

Postoperative Mortality ◽

Mortality Rates ◽

Mortality Prediction ◽

Gastrointestinal Tumors ◽

Mortality And Morbidity ◽

Possum Score ◽

Operative Severity Score ◽

Number Of Patients

AbstractThe aim of this study was to evaluate whether the addition of immunological variables to the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) scoring system improves the predictability of postoperative mortality. One hundred and thirty-two consecutive patients who underwent moderate, major or major-plus elective surgical interventions for gastrointestinal tumors were scored using the POSSUM mortality risk analysis. Patients were placed in one of the two groups based on their POSSUM mortality rates which were either lower or higher than 5%. An additional 26 pre-operative and post-operative metabolic and immunological variables were measured and mortality-dependent variables were selected. Regression analysis with backward elimination of twelve pre-operative and post-operative variables correlating with POSSUM score revealed that post-operative neopterin, IL-6 and albumin were significantly dependent on the predicted mortality rates. According to these selected variables, the number of patients with a POSSUM predicted mortality rate higher than 5% increased from 64 to 88, but the percentage of the mean mortality decreased. Statistical differences between the original POSSUM and modified scoring system was highly significant (p<0.0001). The sensitivity and specificity of the modified scoring system was calculated to be 52.9% and 87.5%, respectively.

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Evaluation of the Use of POSSUM and P-POSSUM Score as a Tool for Prediction of Surgical Outcome

Journal of Surgical Sciences ◽

10.3329/jss.v21i1.43832 ◽

2019 ◽

Vol 21 (1) ◽

pp. 11-14

Author(s):

Mohammad Saif Uddin ◽

Samiron Kumar Mondal ◽

Sharmistha Roy ◽

Masrur Akbar Khan ◽

ABM Khurshid Alam ◽

...

Keyword(s):

Surgical Outcome ◽

Pearson Correlation ◽

Area Under The Curve ◽

Scoring Systems ◽

Surgical Patient ◽

P Value ◽

Mortality And Morbidity ◽

Exact Test ◽

Possum Score ◽

Operative Severity Score

Background: There are many scoring systems that predict the risk of mortality with varyingdegrees of accuracy. The ideal scoring system for surgical outcome should be quick andeasy to use and should be applicable to all general surgical procedures. POSSUM(Physiological and Operative Severity Score for enumeration of Mortality and Morbidity) andP-POSSUM (Portsmouth POSSUM) are the most appropriate scoring systems currentlyavailable in general surgery to predict thirty days mortality and morbidity. Objective: The study was done to assess the value of POSSUM in predicting the morbidityrate and the value of P-POSSUM in predicting the mortality rate in general surgical patientsof our country. Methods: Aprospective study was performed in 120 general surgical patient. The risks ofmorbidity and mortality were calculated by using the POSSUM equation for morbidity andthe P-POSSUM equation for mortality in each patient. The predicted risks were comparedwith the observed risks of morbidity and mortality for 30 days after surgery and statisticallyanalysed. Results: The difference in p value of predicted risk of morbidity by POSSUM equation andobserved morbidity; calculated by chi square test(x2 =1.36, d.f=4,p=0.24,0/P ratio was1.18); which was not statistically significant. The predicted mortality by P-POSSUM equationand observed mortality; calculated by Fisher's exact test(p=1) was not found statisticallysignificant. The Pearson correlation has shown significant correlation at the 0.01 level (2tailed) for the observed and predicted mortality and morbidity(r=O. 701).ROC analysesshowed both POSSUM and P-POSSUM scores to be good predictors of 30-day morbidity andmortality with area under the curve values (AUC) of 0.887 and 0.991 respectively. ConclusionPOSSUM and P-POSSUM can be used as a valid tool for using risk prediction of morbidityand mortality in our set up. Journal of Surgical Sciences (2017) Vol. 21 (1) :11-14

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Perioperative Risk Stratification: A Need for an Improved Assessment in Surgery and Anesthesia—A Pilot Study

Medicina ◽

10.3390/medicina57101132 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1132

Author(s):

Bianca-Liana Grigorescu ◽

Irina Săplăcan ◽

Marius Petrișor ◽

Ioana Roxana Bordea ◽

Raluca Fodor ◽

...

Keyword(s):

Elective Surgery ◽

Scoring Systems ◽

Apache Ii ◽

Mortality And Morbidity ◽

Asa Score ◽

Possum Score ◽

Operative Severity Score ◽

Postoperative Intensive Care ◽

Severity Scores ◽

Significant Difference

Background and Objectives: Numerous scoring systems have been introduced into modern medicine. None of the scoring systems assessed both anesthetic and surgical risk of the patient, predict the morbidity, mortality, or the need for postoperative intensive care unit admission. The aim of this study was to compare the anesthetic and surgical scores currently used, for a better evaluation of perioperative risks, morbidity, and mortality. Material and Methods: This is a pilot, prospective, observational study. We enrolled 50 patients scheduled for elective surgery. Anesthetic and surgery risk was assessed using American Society of Anesthesiologists (ASA) scale, Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), Acute Physiology and Chronic Health Evaluation (APACHE II), and Surgical APGAR Score (SAS) scores. The real and the estimated length of stay (LOS) were registered. Results: We obtained several statistically significant positive correlations: ASA score–P-POSSUM (p < 0.01, r = 0.465); ASA score–SAS, (p < 0.01, r = −0.446); ASA score–APACHE II, (p < 0.01 r = 0.519); predicted LOS and ASA score (p < 0.01, r = 0.676); predicted LOS and p-POSSUM (p < 0.01, r = 0.433); and predicted LOS and APACHE II (p < 0.01, r = 0.454). A significant negative correlation between predicted LOS, real LOS, ASA class, and SAS (p < 0.05) was observed. We found a statistically significant difference between the predicted and actual LOS (p < 001). Conclusions: Anesthetic, surgical, and severity scores, used together, provide clearer information about mortality, morbidity, and LOS. ASA scale, associated with surgical scores and severity scores, presents a better image of the patient’s progress in the perioperative period. In our study, APACHE II is the best predictor of mortality, followed by P-POSSUM and SAS. P-POSSUM score and ASA scale may be complementary in terms of preoperative physiological factors, providing valuable information for postoperative outcomes.

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Efficacy of Possum in Surgical Audit of Patient Undergoing Emergency Surgery at Nepalgunj Medical College

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v14i2.21526 ◽

2018 ◽

Vol 14 (2) ◽

pp. 2-7

Author(s):

S V Bharti ◽

S M Mishra ◽

R R Ranjitkar ◽

A O Chhetri

Keyword(s):

Risk Factors ◽

Emergency Surgery ◽

Severity Score ◽

Scoring System ◽

College Teaching ◽

Treatment Modalities ◽

Mortality And Morbidity ◽

Medical College ◽

Operative Severity Score ◽

Significant Difference

Introduction: The Physiological and Operative Severity Score for the en Umeration of Mortality and morbidity (POSSUM) has been proposed as a method for standardizing patient data so that direct comparisons can be made in spite of differing patterns of referral and population.Aims and objectives: To evaluate the efficacy of a scoring system for predicting the incidence of postoperative complications and mortality in patient undergoing Emergency Surgeries based on the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM).Material and Methods: This is a hospital based cross sectional study of all the cases that had undergone Emergency Surgery at Nepalgunj Medical College Teaching Hospital from the period of July 2014 to June 2015. The period of follow up was 30 days following the surgical procedure? A total of 100 emergency surgeries, as defined by the POSSUM scoring system criteria were studied. Predicted mortality and morbidity rates were calculated using the POSSUM equation by exponential analysis method. It was then compared with the actual outcomes. Observed: Expected Ratio (O:E) was calculated and difference detected by chi-square test. The risk factors as scored in the POSSUM criteria were noted.Results: Applying exponential analysis, an observed to expected ratio (O:E) for mortality of 0.44 was obtained, indicating significant 2 difference between the predicted and observed values (x =93.207, df 63, p=0.008). But, an observed to expected ratio (O:E) for 2 morbidity of 1.01 was obtained and there was no significant difference between the predicted and observed values (x =76.295, df 71, p=0.312). It was found to be comparable to other studies. In all the risk factors studied, a positive correlation was found between deaths and post-operative complications with higher POSSUM scores.Conclusion: POSSUM scoring system could accurately predict overall morbidity while it over predicted the overall mortality. POSSUM scoring system serves as a good predictor of post-operative outcome in major general surgical procedures and was applicable even in our setup and be used for comparing various treatment modalities and assessing the quality of care provided. JNGMC Vol. 14 No. 2 December 2016, page: 2-7

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The influence of the Kinesio Taping on selected ultrasonography measurements, and quality of life in patients with rotator cuff lesions

Scientific Reports ◽

10.1038/s41598-020-75701-6 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Aneta Bac ◽

Magdalena Wróbel ◽

Katarzyna Ogrodzka-Ciechanowicz ◽

Edyta Michalik ◽

Anna Ścisłowska-Czarnecka

Keyword(s):

Quality Of Life ◽

Rotator Cuff ◽

Statistical Significance ◽

Control Group ◽

Subacromial Space ◽

Kinesio Taping ◽

Significant Difference ◽

Rotator Cuff Lesions ◽

Significant Change

Abstract The assessment of the six-week influence of Kinesio Taping combined with a rehabilitation on selected ultrasonography measurements, the level of disability, and the quality of life in patients with rotator cuff lesions. 60 participants were randomly assigned into a taping group (KT combined with a six-week rehabilitating protocol) and a control group (only rehabilitation protocol). In all patients the following assessments were performed twice: USG, UEFI and NHP questionnaires. In the examination of the subacromial space and the subacromial bursa in the taping group, no statistical significance was observed. A statistically significant change in the thickness of the muscles was obtained only for the thickness of the infraspinatus in the taping group. A statistically significant change was obtained in the assessment of tendinopathy only for the supraspinatus muscle in both groups. Within both groups a statistically significant difference was observed in the average UEFI and NHP scores; however, the differences in the scores obtained between the groups were not statistically significant. The use of KT with a rehabilitation program did not yield statistically significantly better results in the improvement of selected shoulder region indicators, the function of the upper limb and the quality of life.

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Wybrane parametry jakości ucisku i relaksacji klatki piersiowej wykonywanej przez personel pielęgniarski w ramach pozaszpitalnego nagłego zatrzymania krążenia ? badanie pilotażowe

Medycyna Rodzinna ◽

10.25121/mr.2018.21.4.328 ◽

2018 ◽

Vol 21 (4) ◽

Author(s):

Paweł Więch ◽

Marek Muster ◽

Dariusz Bazaliński ◽

Grzegorz Kucaba ◽

Izabela Sałacińska ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Statistical Analysis ◽

Discharge Rate ◽

Statistical Significance ◽

Sudden Cardiac Arrest ◽

Initial Examination ◽

Relaxation Parameters ◽

Primary Health

Introduction. Sudden cardiac arrest (SCA) in out-of-hospital conditions is a frequent condition of immediate life-emergency of cardiological background. The survival and discharge rate in SCA patients treated by medical services is still at a low level. Aim. The aim of the study was to analyze selected parameters of the quality of chest compressions and relaxation performed by nursing staff as part of out-of-hospital SCA. Material and methods. The study covered a group of 48 nurses working in primary health care in branches of conservative (PRE/C = 24 people, mean age 33.04 ± 9.20) and surgery profile (PRE/I = 24 people, average age 31.88 ± 9.97), participating in the research project of the Center for Medical and Natural Sciences Research and Innovation, University of Rzeszów in Rzeszów. Two months after the initial examination and intervention, the test was repeated. The assessment of selected compression and relaxation parameters was performed using the True CPR Resuscitation Assistant. The statistical analysis of the collected material was carried out with the SPSS Statistics 20 software. The statistical analysis used the analysis of variables using parametric and non-parametric tests. The statistical significance was assumed at p < 0.05. Results. Initially, a high percentage of the effectiveness of the most important compression and relaxation parameters of the chest was obtained during 2-minute out-of-hospital cardiopulmonary resuscitation with no statistically significant differences between the two groups (PRE/C: 51 mm depth, 83.92% relaxation, frequency 115.46 vs. PRE/I: depth: 47.58 mm, relaxation: 92.54, frequency: 109.96, p < 0.05). After two months, similar parametric values were observed with no statistical significance (p < 0.05). Conclusions. The initial high quality of compressions and relaxation was found in nurses participating in the simulated out-of-hospital SCA, while there were no significant differences between primary health care nurses working at conservative departments and nurses from surgical ones. After a two-month interval from the initial examination and training, high CPR effectiveness was observed based on the guidelines of the European Resuscitation Council from 2015.

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Public Reproductive Health Facilities: A Client-Satisfaction Survey

Global Journal of Health Science ◽

10.5539/gjhs.v9n2p208 ◽

2016 ◽

Vol 9 (2) ◽

pp. 208

Author(s):

Fariba Moradi ◽

Zohreh Balaghi ◽

Mohsen Moghadami ◽

Hassan Joulaei ◽

Najaf Zare

Keyword(s):

Health Care ◽

Socioeconomic Status ◽

Quality Of Health Care ◽

Client Satisfaction ◽

Service Providers ◽

Health Facilities ◽

Health Centers ◽

Significant Difference ◽

Improvement Programs

INTRODUCTION: Understanding clients’ perspectives on quality improvement programs is essential to achieve the goals of health services. Determining client satisfaction could help decision makers to implement programs fit to their needs as perceived by service providers and clients. This study aimed to assess the level of satisfaction among women attending health centers regarding the services received in governmental health facilities in Shiraz, southern Iran.METHOD: This cross-sectional study was performed in 24 urban health centers. Using systematic random sampling method, 8 clinics were assigned to each group. Then questionnaires were distributed among 240 married women in 15-49 year-old age group who had referred to selected clinics for receiving some services. For data analysis, SPSS version 15 software and Chi-square statistical procedure were used to evaluate clients’ satisfaction.RESULTS: Data showed that 101 out of 240 respondents were completely satisfied with the personnel as well as the health center. Furthermore, satisfaction was found to be the highest among clients of those centers ranked as middle class socioeconomic status, while no significant difference was found between centers based on their socioeconomic status.CONCLUSION: The results of the present study would enable policy-makers to effectively improve the quality of health care, keeping a balance between providers’ and patients’ perspectives on the quality of health care.

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