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

2018 ◽  
Vol 5 (7) ◽  
pp. 2523 ◽  
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.

scholarly journals Pre-NELA vs NELA – has anything changed, or is it just an audit exercise?

2016 ◽  
Vol 98 (8) ◽  
pp. 554-559 ◽  
Author(s):  
M Mak ◽  
AR Hakeem ◽  
V Chitre
Keyword(s):  
Critical Care ◽  
High Risk ◽  
Uneventful Recovery ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
High Risk Patients ◽  
Possum Score ◽  
Operative Severity Score ◽  
Risk Patients ◽  
Set Up

BACKGROUND Following evidence suggestive of high mortality following emergency laparotomies, the National Emergency Laparotomy Audit (NELA) was set up, highlighting key standards in emergency service provision. Our aim was to compare our NHS trust’s adherence to these recommendations immediately prior to, and following, the launch of NELA, and to compare patient outcome. METHODS This was a retrospective study of patients who underwent an emergency laparotomy over the course of 6 months – 3 months either side of the initiation of NELA. RESULTS There were 44 patients before the initiation of NELA (pre-NELA, PN group) and 55 in the first 3 months of NELA (N group). We saw a significant increase in the proportion of patients whose decision to operate was made by the consultant: 75.0% in the PN group vs 100% in N group (subsequent data presented in this order) (P < 0.001). The presence of a consultant surgeon (75.0% vs 83.6%, P = 0.321) and anaesthetist (100.0% vs 90.9%, P = 0.064) in theatres were comparable in both groups. Risk stratification based on Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) score showed no difference in high-risk patients in both groups (47.7% vs 36.4%, P = 0.306). With the NELA initiative, however, significantly more patients were admitted directly from theatres to the critical care unit, when compared with the pre-NELA period (9.1% vs 27.3%, P = 0.038). This also reflected a significant reduction in unexpected escalation to a higher level of care during this period (10.0% vs 0%, P = 0.036). Significantly more patients had uneventful recovery in the NELA period (52.3 vs 76.4%, P = 0.018), although there was no difference in 30-day mortality between the groups (2.3% vs 7.3%, P = 0.378). CONCLUSIONS This study demonstrated a greater degree of consultant involvement in the decision to operate during NELA. More high-risk patients have been identified preoperatively with diligent risk assessment and, hence, have been proactively admitted to critical care units following laparotomy, which may account for the significant reduction in unexpected escalation to level 2 or level 3 care and thus in overall better patient outcomes.

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

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. 

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

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.

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

2019 ◽  
Vol 6 (10) ◽  
pp. 3600
Author(s):  
Karthic Anbarasu ◽  
Rohit Chandak
Keyword(s):  
Prospective Study ◽  
Health Care Cost ◽  
Tertiary Care ◽  
Exploratory Laparotomy ◽  
Morbidity Rate ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
Targeted Interventions ◽  
Possum Score ◽  
Operative Severity Score

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. 

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

Pteridines ◽  
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.

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

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

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

2017 ◽  
Vol 5 (7) ◽  
pp. 3007
Author(s):  
Prasan Kumar Hota ◽  
Harshita Yellapragada
Keyword(s):  
Health Care ◽  
Surgical Outcome ◽  
Scoring System ◽  
Statistical Significance ◽  
Surgical Care ◽  
Mortality And Morbidity ◽  
Possum Score ◽  
Operative Severity Score ◽  
Significant Difference

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.

Mortality risk scoring in emergency general surgery: Are we using the best tool?

2020 ◽  
pp. 175045892092013
Author(s):  
Azeem Thahir ◽  
Rui Pinto-Lopes ◽  
Stavroula Madenlidou ◽  
Laura Daby ◽  
Chandima Halahakoon
Keyword(s):  
Mortality Rate ◽  
Goodness Of Fit ◽  
Characteristic Curve ◽  
Emergency Laparotomy ◽  
Receiver Operator Characteristic ◽  
Characteristic Analysis ◽  
Goodness Of Fit Test ◽  
Risk Of Death ◽  
Possum Score ◽  
Operative Severity Score

Background It is imperative that an accurate assessment of risk of death is undertaken preoperatively on all patients undergoing an emergency laparotomy. Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) is one of the most widely used scores. National Emergency Laparotomy Audit (NELA) presents a novel, validated score, but no direct comparison with P-POSSUM exists. We aimed to determine which would be the best predictor of mortality. Methods We analysed all the entries on the online NELA database over a four-and-a-half-year period. The Hosmer–Lemeshow goodness of fit test was performed to assess model calibration. For the outcome of death and for each scoring system, a non-parametric receiver operator characteristic analysis was done. The sensitivity, specificity, area under receiver operator characteristic curve and their standard errors were calculated. Results Data pertaining to 650 patients were included. There were 59 deaths, giving an overall observed mortality rate of 9.1%. Predicted mortality rate for the P-POSSUM score and NELA score were 15.2% and 7.8%, respectively. The discriminative power for mortality was highest for the NELA score (C-index = 0.818, CI: 0.769–0.867, p < 0.001), when compared to P-POSSUM (C-index = 0.769, CI: 0.712–0.827, p < 0.001). Conclusions The NELA score showed good discrimination in predicting mortality in the entire cohort. The P-POSSUM over-predicted observed mortality and the NELA score under-predicted observed mortality.

scholarly journals Effectiveness of clinical abdominal scoring system in the management of patients with blunt trauma abdomen

2021 ◽  
Vol 8 (4) ◽  
pp. 1175
Author(s):  
Dharmendra Kumar ◽  
Mohan Kumar K.
Keyword(s):  
Blunt Trauma ◽  
Scoring System ◽  
Motor Vehicle ◽  
Total Mortality ◽  
Emergency Laparotomy ◽  
Solid Organ ◽  
Radiological Investigation ◽  
Mortality And Morbidity ◽  
Common Causes ◽  
The Common

Background: Abdominal injury being the most common cause of mortality and morbidity, its incidence comes after extremities and head injury. Early diagnosis and treatment can reduce mortality by upto 50%. The common causes for blunt trauma abdomen include motor vehicle crashes, direct trauma and fall from heights. Objectives of the current investigation were to score the patients with BTA with clinical abdominal scoring system and to compare the score of CASS with USG/CT abdomen and pelvis findings in patients of BTA. Methods: All patients who are suspected to have BTA were scored using CASS and radiological investigations were done in the ED. The decision to proceed with the surgery would be done if the patient had CASS >12 and/or if the radiological investigation shows features of BTA like air under diaphragm or grade IV/V solid organ injury.Results: Males accounts for 81% of cases and the rest being females. Most common mode of injury was found to be RTA. Most common injured organs are spleen >liver >small intestine (ileum). The CASS has specificity of 84.62%, sensitivity of 99.2%, PPV 33.3%, NPV 100%. Total mortality in the study was 7.1%Conclusions: Patients with CASS of <8 can be managed conservatively. Patient with score >12 or hemodynamically unstable can be taken up for emergency laparotomy without any delay. Patients with CASS between 9 and 11, with good clinical assessment aided with radiological investigations can be managed depending upon the severity of the injury.

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