A study on evaluation of possum scoring system in patients undergoing laparotomy

Vijayalakshmi, G (2016) A study on evaluation of possum scoring system in patients undergoing laparotomy. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION: Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) has been used to produce numerical estimate of expected mortality and morbidity after variety of surgical procedures. It can be used in hospital setting to provide educational information. It integrates well in the existing hospital programs without causing any disruptions of hospital activities. AIMS & OBJECTIVES: POSSUM is a patient risk prediction model based on 12 patient characteristics and 6 characteristics of the surgery performed. The objective of the present study is to assess the accuracy of POSSUM in predicting mortality and morbidity in patients undergoing laparotomy in both elective and emergency settings MATERIALS & METHODS: Sample size of 150 has been calculated. A prospective and descriptive study design was formulated and the study was conducted in govt. Stanley medical college, Chennai. The duration of the study was from 01 Oct 2014 to 30 Aug 2015. An informed consent was obtained from all patients/their legal guardian. During hospitalisation, appropriate work up as deemed necessary was done. Physiological severity was scored on admission. All patients were operated under general anaesthesia. The operative severity was scored after a period of 30 days. RESULTS & DISCUSSION: In elective patients, the expected to observed morbidity was similar, but significance couldn't be attributed as the prevalence of morbidity as such was low in that group. Among those who had post surgical complications, their POSSUM score was high, indicating a good specificity of the score. In the emergency group, the correlation was significant with the predicted morbidity levels being the same as what was actually seen in the study. A graph showing the expected to observed ratio showed that the two lines were parallel and close to each other, indicating a significant level of correlation. Out of the 50 odd patients who had a morbidity predicted percentage of more than seventy, forty two patients developed post surgical complications indicating a high level of sensitivity and specificity for the score to predict morbidity With regards to mortality, the low rates of mortality in the study precludes any meaningful analysis. Among the five patients who died, their POSSUM predicted mortality percentage was more than ninety in four of the cases and conversely out of the six patients who had a POSSUM score of more than ninety percent, four patients died. This again indicates a high level of sensitivity and specificity of the score to predict mortality. Chi Square analysis of the significance of POSSUM score to predict morbidity and mortality among our study group patient showed a high level of significance <0.001 for both mortality and morbidity. CONCLUSION: POSSUM morbidity equation can reasonably predict morbidity in high risk groups whereas the sensitivity falls in elective conditions. POSSUM mortality equation over predicts mortality especially in low risk groups, while the predictive value improves significantly when exponential analysis is used. Hence POSSUM scoring system has an undeniable advantage in our set up for better patient counseling, improving the surgical outcomes in both emergency and elective wards and for better management of limited resources and manpower.

Item Type: Thesis (Masters)
Uncontrolled Keywords: possum scoring system ; patients ; undergoing laparotomy.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 27 Sep 2017 02:45
Last Modified: 27 Sep 2017 02:45
URI: http://repository-tnmgrmu.ac.in/id/eprint/3383

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