Comparative analysis of P-POSSUM score at admission and pre-operatively in predicting postoperative mortality in patients undergoing emergency laparotomy

Abstract

Laprotomy remains one of the commonest emergency surgical procedure performed worldwide. But over the last few years, various perioperative quality improvement initiatives involving early interventions, intensive postoperative care, and indivisualised care approaches have ensured a decrease in the average mortality rate by 3.8%-8.3. An ideal scoring system should accurately predict outcomes, help determine who deserves more aggressive care, guide in deciding the extensiveness of surgery, and can be used broadly access emergency laprotomies for various disease pathologies. The scoring system should also be capable of analyzing risk adjusted morbidity and mortality amongst various healthcare providers. To access the accuracy of P-POSSUM score on predicting the mortality and morbidity in emergency laparotomy patients and to establish that the preoperative score is more accurate that admission score. 150 Cases of emergency laparotomy in General Surgery Department in IGIMS, Patna from September, 2020 to February, 2022 were taken up in this study. Patients below 18 years, routine surgery and 6 patients who could not be followed up for complete 30 days were excluded. Physiological P-POSSUM was calculated at the time of admission and just before operation, post resuscitation. Operative score was same for both Physiological P-POSSUM scores. Mortality predicted at admission had statistically significant difference and p value was<0 xss=removed>.05. Most common complication was wound infection followed by septicaemia. P-POSSUM is a better predictor of mortality and morbidity in emergency laparotomies when scoring is done preoperatively.