An Evaluation of Efficacy of the Portsmouth Possum Scoring System for Predicting Morbidity and Mortality in Elective and Emergency Abdominal Surgeries

Abstract Background: Surgical risk assessment is crucial for predicting postoperative outcomes and optimizing patient care. The Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) has been widely used to estimate morbidity and mortality in surgical patients. This study evaluates the accuracy of P-POSSUM in predicting outcomes for patients undergoing elective and emergency abdominal surgeries at ASRAM, Eluru, Andhra Pradesh. Methods: A prospective study was conducted on 150 patients undergoing abdominal surgeries. P-POSSUM scores were calculated based on physiological and operative parameters. The observed morbidity and mortality rates were compared with predicted values using statistical models, including the observed-to-expected (O:E) ratio and Receiver Operating Characteristic (ROC) curve analysis. Results: The study included 150 patients (59.3% male, 40.7% female), with 75.3% under 60 years of age. Elective surgeries accounted for 72.7%, while 27.3% were emergency procedures. The observed mortality rate was 10%, and morbidity occurred in 96.7% of patients. ROC curve analysis demonstrated high predictive accuracy for mortality (AUC = 0.898) and moderate accuracy for morbidity (AUC = 0.742). The comparison of observed versus expected outcomes confirmed P-POSSUM’s validity in mortality prediction, though morbidity estimation showed some variance. Conclusion: P-POSSUM is a reliable tool for predicting mortality in abdominal surgeries, aiding in preoperative risk assessment and perioperative management. While morbidity prediction requires refinement, the scoring system remains valuable for surgical risk stratification. Further studies are recommended to enhance its predictive accuracy for morbidity outcomes.