Vikram Birla, R (2020) Possum Scoring in Predicting the Mortality and Morbidity of Patients Undergoing Emergency Laparotomy in Tirunelveli Medical College Hospital. Masters thesis, Tirunelveli Medical College, Tirunelveli.
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Abstract
INTRODUCTION: The Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM) is a scoring system that is used to predict 30 day mortality and morbidity rates in patients who are undergoing surgery. POSSUM stands for Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity. It was developed by Copeland in 1991. Emergency laparotomy is a common procedure having mortality rate considerably greater than that of elective laparotomy. Measuring the outcome of emergency laparotomy is crucial for both the patient and health providers, in which improvementin the health service can be achieved. AIM OF THE STUDY: 1. Evaluation of POSSUM equation in patients undergoing EMERGENCY LAPAROTOMY 2. To identify high risk patients who could be benefited from preoperative optimization to provide better surgical care to the patients. MATERIALS AND METHODS: A prospective cross-sectional study that include patients who is undergoing Emergency Laparotomy from seven general surgical units at TVMCH from the period of December 2017- June 2019. Data was collected prospectively on a proforma prepared for the study, from the patients undergoing emergency laparotomy. All such patients would have their physiological score recorded on admission. An operative severity score was calculated based on findings recorded on the proforma. The risk of mortality was calculated using POSSUM equation. RESULTS: In this study, we studied 170 patients who underwent Emergency Laparotomy during the period of December 2017-June 2019 with follow up for 30 days, To observe the mortality and morbidity and possible intervention to improve the prognosis of the high risk patient. Most common indication for emergency laparotomy in this study is Duodenal perforation (74), secondly Gastric perforation (17) followed by ileal perforation (10). Male were the predominantly affected with total 133 patients and 37 females. Most common age group affected is 40 to 60. In our study we observed total of 16 deaths 9.6% and 63 patients with complications 36.4%. Most common cause for death is Duodenal perforation. Most common complications follow by Emergency surgery is Surgical Site Infection 11.2% followed by LRI 5.9%. Possum scoring system was applied to predict the post operative mortality and morbidity. On analyzing observed and predicted value, there was no statistically significant difference between the observed and predicted value of mortality (P=1) and morbidity (P=0.56). CONCLUSION: In Surgical Audit Crude mortality and morbidity is an unreliable indicator so with the use of Possum scoring system patient specific mortality and morbidity can be assessed. Possum scoring system is one of the dependable scoring system to assess the post operative patient. High risk patients can be benefited from peri-operative optimization. In our study there was No statistically significant variation noted between the observed as well as predicted Morbidity (P=0.56) and Mortality (P=1.00). Hence the current study suggests that the POSSUM scoring system is a most reliable for predicting post-operative mortality and morbidity and which may help to improve the prognosis of the patients.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711370 |
| Uncontrolled Keywords: | Possum, Risk Score, Emergency Laparotomy, Mortality, Morbidity. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 11 Feb 2021 02:47 |
| Last Modified: | 11 Feb 2021 02:47 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14048 |
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