EFFICACY OF PREDICTING THE MORTALITY AND MORBIDITY IN EMERGENCY LAPAROTOMY CASES USING POSSUM AND P-POSSUM SCORING SYSTEM

DR. SIDDHARTHA SANKAR BHATTACHARJEE; DR. DHINESH KUMAR. N

Volume : IX, Issue : I, January - 2020

EFFICACY OF PREDICTING THE MORTALITY AND MORBIDITY IN EMERGENCY LAPAROTOMY CASES USING POSSUM AND P-POSSUM SCORING SYSTEM

Dr. Siddhartha Sankar Bhattacharjee, Dr. Dhinesh Kumar. N

Abstract :

Introduction In the culture of increased scrutiny, surgeons must be able to clearly and accurately demonstrate how they perform, through comparative audit of their surgicaloutcomes1. Even if the patient reaches the hospital in time and is operated, the post–operative period is still unpredictable. Perforation peritonitis is one of the most encountered surgical emergencies in which patient presents with acute abdomen. It is the most common surgical emergency in India2.Secondary peritonitis is the consequence of contamination of the peritoneal cavity due to contents of organ within the peritoneal cavity. Majority of these episodes are due to lesions in stomach, duodenum, small intestines, appendix and colon3. Mortality due to hollow viscous perforation ranges from 10% to 40 % 4. Crude morbidity and mortality rates are limited indicators of quality of care, and can be misleading when the results of emergency surgery are compared between different units and hospitals. Scoring systems that group patients based on the severity of illness before treatment can allow a meaningful analysis of morbidity and mortality rates. Mortality is an important and objective measure of outcome. The ideal scoring system for surgical audit purposes should assess mortality and morbidity and should allow audit retrieval of the surgical success. It should be quick and easy to use and should be applicable to all general surgical procedures in both the emergency and elective setting. It should be of use in all types of hospital and should provide educational information. Finally it should be possible to integrate the scoring system into pre–existing audit programmes with the minimum of disruption5. The Physiological Operative Severity Score for the enUmeration of Mortality and morbidity {POSSUM} is in widely used to predict morbidity and mortality in a variety of surgical settings, and provides a tool for risk adjustment and comparison. All 12physiological and 6 operative variables required for POSSUM scoring can be recorded easily and reproduced satisfactorily by resident staff with minimal difficulty. Any comparative system that over predicts mortality and morbidity has the effect of making poor results look better. The Portsmouth predictor modification {P–POSSUM}proposed by Whiteley et al 6,7 counters the over prediction of mortality in low risk patients by POSSUM. The variables used are the same but a different formula is used to predict the risk of death. Differences in predictive values of two scoring systems are related to the method of analysis. Wijesinghe et al 8 directly compared the exponential and linear methods of analysis; use of linear analysis for POSSUM or exponential analysis for P–POSSUM yielded spurious results by over predicting mortality. Compå the outcome for such patients using data from developed countries or centres with selection bias may be misleading. MATERIALS AND METHODS Some 100 cases who underwent emergency laparotomy under surgical units at Silchar Medical College and Hospital, Silchar. Data collected were based on hospital based prospective observational study. The study period was from JUNE 2017 TO MAY 2018 for a period of one year. All patients admitted in surgery department of Silchar Medical College and Hospital during the study period and meeting the inclusion and exclusion criteria will be included in this study. RESULTS Out of 100 patients included in the study, 21 individuals (21%) were females and 79 individuals (79%) were males. Out of these ,nine individuals died ( two females and 7 males).(p >0.05 ;statistically not significant) Conclusion: Portsmouth POSSUM scoring system serves as a good predictor of postoperative outcome in emergency laparotomy procedures.