Comparative Performance of POSSUM and Jabalpur Peritonitis Index for Predicting Outcomes after Emergency Laparotomy for Perforation Peritonitis: An Observational Study

Abstract Background: Secondary peritonitis is a common surgical emergency associated with the high morbidity and mortality. Prognostic scoring systems are useful for perioperative risk stratification, particularly in resource-limited settings. This study compared the predictive accuracy of Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Jabalpur Peritonitis Index (JPI) in patients undergoing emergency laparotomy for perforated peritonitis. Materials and Methods: A single-center observational study was conducted at a tertiary teaching hospital between January 2022 and December 2023. Seventy-seven consecutive patients aged ≥16 years with perforated peritonitis undergoing emergency laparotomy were enrolled. POSSUM and JPI scores were calculated using perioperative data. Primary outcomes were in-hospital morbidity and mortality. Diagnostic performance was assessed using receiver operating characteristic curves, sensitivity, specificity, and area under the curve (AUC). Results: Of 77 patients, 6 (7.8%) died and 59 (76.6%) developed postoperative complications, most commonly hypotension (26%), respiratory failure (16.9%), and wound infection (14.3%). For mortality prediction, POSSUM (AUC = 0.839, 95% CI = 0.727–0.951) and JPI (AUC = 0.884, 95% CI = 0.785–0.981) demonstrated comparable discriminatory performance, each achieving 100% sensitivity and 67.6% specificity at optimal cutoffs. For morbidity prediction, POSSUM (AUC = 0.844, 95% CI = 0.757–0.932) yielded sensitivity 77.4% and specificity 84.8%, while JPI (AUC = 0.820, 95% CI = 0.725–0.916) achieved sensitivity 74.2% and specificity 80.4%. No statistically significant difference between the AUCs of POSSUM and JPI for either mortality ( P = 0.575) or morbidity prediction ( P = 0.892). Conclusions: POSSUM and JPI demonstrated similar accuracy for predicting morbidity and mortality in perforated peritonitis. Both can be applied for prognostication, with selection determined by local context, resource availability, and clinical preference.