POSSUM AND PORTSMOUTH POSSUM scoring for surgical assessment in predicting mortality and morbidity in emergency abdominal surgeries.

POSSUM AND PORTSMOUTH POSSUM SCORING FOR SURGICAL ASSESSMENT IN PREDICTING MORTALITY AND MORBIDITY INEMERGENCY ABDOMINALSURGERIES

INTRODUCTION**:**

Surgery is considered one of the essential healthcare services. As many demographic parameters have shifted over the years, there has been an increase in emergency surgeries in India. This increase is attributed to population growth.

 Crude morbidity and mortality rates are limited indicators of quality of care, and can be misleading when the results of emergency surgery are compared between different units and hospitals. Scoring systems that group patients based on the severity of illness before treatment can allow a meaningful analysis of morbidity and mortality rates. Risk-adjusted comparisons can then be made between surgeons and hospitals.

 The Physiological Operative Severity Score for the enumeration of Mortality and morbidity {POSSUM} is widely used to predict morbidity and mortality in a variety of surgical settings, and provides a tool for risk adjustment and comparison.

Risk scoring helps us quantify the prospects of adverse outcome in a patient.

 POSSUM as well as, Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) , both over the world have proved itself as a worthy scoring system and the present study is being done to evaluate the feasibility of POSSUM SCORING SYSTEM and  PORTSMOUTH-POSSUM SCORING SYSTEM as a risk scoring system as a tool in efficacious prediction of mortality and morbidity in EMERGENCY ABDOMINAL SURGERIES in our demographic profile and which system is better applicable

The Physiological and Operative Severity Score for enumeration of Mortality and morbidity {POSSUM}

And

PORTSMOUTH- POSSUM.

have been devised specifically for prediction in surgical patients. It uses 12 physiological and 6 operative variables to give a calculated risk of morbidity and death. POSSUM was intended to be used in Evaluation of Possum Scoring In Patients Undergoing Emergency surgeries .

The Physiological variables being

1. Age

2. Cardiac signs

3. Chest Xray (cardiac changes) , Chest Xray (respiratory changes)

4. Systolic B.P

5. Pulse rate (bpm)

6. Glasgow coma scale

7. Hemoglobin

8. WBC Count

9. Blood Urea(mmol/l)

10. Serum Sodium(mmol/l), Serum Potassium(mmol/l)

11. ECG Changes

12. Respiratory history

 OPERATIVE SCORING

1. Number of operations within 30 days.

2. Blood loss per operation (ml)

3. Peritoneal contamination.

4. Presence of malignancy.

5. Mode of surgery.

  The POSSUM mortality equation as published by Copeland et al is in

{R/(1-R)}= -7.04 + (0.13 x physiological score) + (0.16 x operative score),

where R is the predicted risk of mortality and is in the standard form of equation as produced by logistical regression.

 The PORTSMOUTH-POSSUM mortality equation as published by Whiteley et al is in

 Loge[R/1-R]=(0.1692xPhysiologicalscore)+(0.155xOperative score)-9.065.

where R = risk of mortality.

 There is much confusion about the way POSSUM scores are analyzed. The result of the POSSUM data set is physiology score of 12-88 and operative score of 6- 44. Although the higher the overall POSSUM score, the greater the risk of morbidity and mortality, individual scores do not reflect the percentage risk. These two scores are most useful as a part of a regression equation that is used to produce a percentage risk. The regression equation includes a constant number and weighted scores for physiology and operative risk {(R/1-R) = -7.04 + (0.13xPS) + (0.16xOS)}. A different constant and weighted value is needed to predict morbidity and mortality.

 2 ) AIMS:

PRIMARY AIM:

Using POSSUM AND P-POSSUM SCORING SYSTEM  to predict mortality and morbidity in patients undergoing emergency abdominal surgeries

SECONDARY AIM:

To evaluate the strength of P-POSSUM SCORING SYSTEM in predicting mortality and morbidity.

  3) MATERIAL AND METHODS:

3.1) STUDY DESIGN: Prospective observational study design  from September 2019 to August 2021  in  KIMS, BBSR.

 **3.2) TIME AND DURATION OF STUDY:**2 years from July 2020 to July 2022

    3.4) Inclusion criteria:

1) All patients undergoing emergency abdominal surgeries

at our hospital, KIMS .

 2)The patients who will be willing to comply with the

study group.

 3.5) Exclusion criteria:

1. Patients aged 18 years or less.

2. In those whom follow up period criteria will not be met

3. Patients with significant immunosuppression

-HIV/HBsAg/HCV positive

-Those on immunosuppressive drugs

-Those on anti-cancer chemotherapeutic drugs

 3.7) Source of data:

Patients who are admitted in the  Department of General surgery, Kalinga Institute of Medical Sciences, Bhubaneswar for emergency abdominal surgeries during the period September 2019 to August 2021.

  3.8)SAMPLE SIZE: 150 patients