Comparison of Acute Physiology and Chronic Health Evaluation (APACHE) II, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), and Surgical Apgar Score in Patients Undergoing Emergency Laparotomy

Background and aim: Surgical risk scoring is essential for predicting postoperative outcomes, guiding ICU admission, and planning interventions. In emergency laparotomies, appropriate scoring systems aid prognostication, risk‑adjusted audits, and quality improvement initiatives. This study aimed to compare the accuracy of the surgical Apgar score (SAS), Acute Physiology and Chronic Health Evaluation (APACHE) II, and Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) in predicting morbidity and mortality among patients undergoing emergency laparotomy at Kempegowda Institute of Medical Sciences (KIMS) Hospital, Bangalore. Methods: This prospective observational study included 65 adult patients undergoing emergency laparotomy between July 2023 and December 2024. Patients were assessed using parameters specific to SAS, APACHE II, and POSSUM. Postoperative complications were monitored on days three, seven, and 15, and graded using the modified Clavien-Dindo classification. Receiver operating characteristic (ROC) curve analysis was used to evaluate predictive validity. Results: Morbidity occurred in 16 patients (24.6%) and mortality in 12 patients (18.5%). Higher SAS values were associated with fewer complications and lower mortality, whereas patients who died had notably lower scores. APACHE II demonstrated strong predictive accuracy, with higher scores significantly associated with adverse outcomes. POSSUM also effectively predicted morbidity and mortality, though with a tendency to overestimate risk in some cases. Conclusion: All three scoring systems demonstrated predictive utility. APACHE II was the most reliable predictor of mortality, POSSUM showed greater accuracy for morbidity, and SAS, despite its simplicity, proved effective for both morbidity and mortality. Its ease of use supports SAS as a practical tool for guiding postoperative care decisions.