AI Article Synopsis
- Laparotomy is a common emergency surgical procedure, and early prognostic evaluation can help identify high-risk patients for better treatment and care.
- The study compared two scoring systems, P-POSSUM and APACHE-II, for predicting postoperative morbidity and mortality in patients undergoing emergency laparotomy at Tata Main Hospital.
- Results showed that both scoring systems have similar predictive abilities, but APACHE-II is more practical as it doesn't require intra-operative data, making it suitable for pre-operative risk assessment.
Article Abstract
Background: Laparotomy remains one of the commonest emergency surgical procedures. Early prognostic evaluation would aid in selecting the high-risk patients for an aggressive treatment. Awareness about risks could potentially contribute to the quality of perioperative care and optimum utilization of resources. Portsmouth modification of Physiological and operative severity for the enumeration of mortality and morbidity (P-POSSUM) and the acute physiology and chronic health evaluation II (APACHE-II) have been the most widely used scoring systems for emergency laparotomies. It is always better to have a single scoring system to predict outcomes and audit healthcare organizations.
Aim: To compare the ability of APACHE-II and P-POSSUM to predict postoperative morbidity and mortality in patients undergoing emergency laparotomy.
Methods: All patients undergoing emergency laparotomy at the Tata Main Hospital, Jamshedpur between December 2013 and November 2014 were included in the study. In this observational study, P-POSSUM and APACHE-II scoring were done, and the outcome analysis evaluated with mortality being the primary outcome.
Results: For P-POSSUM, at a cut off value of 63 to predict mortality using receiver operating characteristics curve analysis, the area under the curve was 0.989; and for APACHE-II, at the cut off value of 24, the area under the curve was 0.965.
Conclusion: Because the ability of APACHE-II to predict mortality was similar to P-POSSUM and APACHE-II does not need scoring for intra-operative findings and histopathology reports, APACHE-II can be used pre-operatively to assess the risk in patients undergoing emergency laparotomy. However, for audit purposes, either of the two scoring systems can be used.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718800 | PMC |
| http://dx.doi.org/10.12998/wjcc.v7.i16.2227 | DOI Listing |
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