A Prospective Observational Study on Efficacy of Possum Scoring System in Predicting Morbidity and Mortality for Patients Undergoing Emergency Laparotomy

Introduction: Emergency laparotomy is usually linked with considerable postoperative morbidity and mortality due to the critical condition of patients and the emergency nature of intervention. Accurate prediction of adverse outcomes is important for optimising the resource allocation and the perioperative care. The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) was initiated to offer an objective method for risk stratification. This study assessed the effectiveness of the POSSUM scoring system in predicting the postoperative morbidity and mortality among patients who undergo the emergency laparotomy. Materials and Methods: This is a prospective observational study which included 129 patients who underwent emergency laparotomy in a tertiary care hospital. Demographic details, laboratory investigations, clinical parameters, operative findings, and postoperative outcomes were recorded by using a structured proforma. The POSSUM scores were recorded for all the participants based on the physiological and operative severity parameters. Institutional Ethical Committee approval was obtained and the written informed consent was obtained from all the participants. Data were analysed using the SPSS software version 21. Descriptive data were expressed as percentages and frequencies. The predictive performance of POSSUM was evaluated by finding the sensitivity, specificity, negative predictive value and positive predictive value for both the morbidity and mortality. Results: POSSUM predicted 111 patients for morbidity, whereas 61 cases developed the postoperative complication, indicating an overestimation of morbidity by this scores. Specificity and sensitivity for morbidity prediction were 25% and 98.4% respectively. For mortality, the POSSUM scoring predicted 67 persons mortality compared to 29 observed deaths, with specificity and sensitivity and of 62% and 100% respectively. The high negative predictive value for mortality had explained its reliability in identifying the low-risk patients. Overall, POSSUM had showed the sensitivity but it had tendency to overpredict the adverse outcomes, particularly the morbidity. Conclusion: POSSUM had proved to be a reliable risk stratification tool for predicting the postoperative mortality and it is a sensitive indicator for morbidity in patients undergoing emergency laparotomy, though it had tendency to overestimate the complications. This scoring system can facilitate early identification of high-risk patients, enabling the clinical decision-making and better perioperative management.