European Journal of Biomedical and Pharmaceutical Sciences

RISK-ADJUSTED ANALYSIS OF PATIENTS UNDERGOING EMERGENCY LAPAROTOMY USING POSSUM AND P-POSSUM SCORE

Dr D.B.Choksi, *Dr. Veer Sachin, Dr. S.M.Damor, Dr. Patel Nirmeet, Dr Pankaj Bharadva and Dr Jisar Shah

ABSTRACT

Over the past few decades, patient outcome has been used as an indicator of patient quality of care, in both developed and developing countries.[1,5,6,10,11] Risk-adjusted analyses are crucial in order to allow comparison of outcomes between surgeons, hospitals, countries and case-mix, which could affect the outcome of a surgical procedure.[1,7] POSSUM (Physiological and Operative Severity Score for the enumeration of Mortality and morbidity), which was developed in 1991, mortality which did not significantly differ from observed rates.[1] The ratio of observed to predicted number of adverse outcomes (O/P ratio) has therefore been used to assess differences between surgeons, units, hospitals and countries.[7] A ratio of 1.00 would indicate average performance; greater than 1.00, worse than expected, and less than 1.00, better than expected.7 The original POSSUM equation over-predicted mortality in low risk patients and under-predicted it in elderly or emergency patients.[2,4,14] P-POSSUM (Portsmouth modification) was formulated to correct this.[2,9] The same variables were used but a different regression equation and constant was employed to calculate the mortality risk.[9] However, it has its own limitations, significantly under-predicting death in the elderly[13,15] as well as in emergencies.[14] POSSUM has been found to accurately predict 30-day morbidity and mortality for a wide range of elective and emergency general surgical procedures, even though it cannot replace highly specific scoring systems for individual disease states.[1.6.7.9.10.11.12] However, when initially developed, POSSUM did not include patients undergoing surgery for trauma.[1.8]

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