Portsmouth physiological and operative severity score for the Enumeration of Mortality and morbidity scoring system in general surgical practice and identifying risk factors for poor outcome

Abstract

Background:Estimation of the outcome is paramount in disease stratification and subsequent management in severely ill surgical patients. Risk scoring helps us quantify the prospects of adverse outcome in a patient. Portsmouth-Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM) the world over has proved itself as a worthy scoring system and the present study was done to evaluate the feasibility of P-POSSUM as a risk scoring system as a tool in efficacious prediction of mortality and morbidity in our demographic profile.Materials and Methods:Validity of P-POSSUM was assessed prospectively in fifty major general surgeries performed at our hospital from May 2011 to October 2012. Data were collected to obtain P-POSSUM score, and statistical analysis was performed.Results:Majority (72%) of patients was male and mean age was 40.24 ± 18.6 years. Seventy-eight percentage procedures were emergency laparotomies commonly performed for perforation peritonitis. Mean physiological score was 17.56 ± 7.6, and operative score was 17.76 ± 4.5 (total score = 35.3 ± 10.4). The ratio of observed to expected mortality rate was 0.86 and morbidity rate was 0.78.Discussion:P-POSSUM accurately predicted both mortality and morbidity in patients who underwent major surgical procedures in our setup. Thus, it helped us in identifying patients who required preferential attention and aggressive management. Widespread application of this tool can result in better distribution of care among high-risk surgical patients.

Pre-Interventional Risk Assessment in The Elderly (PIRATE): Development of a scoring system to predict 30-day mortality using data of the Peri-Interventional Outcome Study in the Elderly

“…In contrast to these scores, PIRATE is based on a Cox regression model that accounts for the characteristics of the survival and censoring processes during the post-interventional 30-day period [ 5 – 7 ]. Further, compared to other scores, we solely included readily available pre -interventional predictors, focussing on a quick and easy risk assessment before intervention [ 6 , 7 ]. Similar to POSPOM, we derived a user-friendly scoring system that is applicable in daily clinical routine [ 5 ].…”

“…POSSUM, P-POSSUM, POSPOM) used a logistic regression model with a binary outcome (dead vs. alive) for score development not accounting for censoring. In contrast to these scores, PIRATE is based on a Cox regression model that accounts for the characteristics of the survival and censoring processes during the post-interventional 30-day period [5][6][7]. Further, compared to other scores, we solely included readily available pre-interventional predictors, focussing on a quick and easy risk assessment before intervention [6,7].…”

“…Commonly used scores such as e.g. the Preoperative Score to Predict Postoperative Mortality (POSPOM), the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM), the Portsmouth-POSSUM (P-POSSUM), the Surgical Outcome Risk Tool (SORT), the National Surgical Quality Improvement Program (NSQIP) Universal Surgical Risk Calculator, the Estimation of Physiologic Ability and Surgical Stress (E-Pass), and the Surgical Risk Scale (SRS) have all been developed on data referring to a wider age range and employing a number of risk factors that are, to some extent, not assessable before intervention [5][6][7][8][9][10][11][12][13].…”

Update on preoperative evaluation and optimisation

“…In a prospective study on fifty subjects undergoing major general surgeries, the validity of P-POSSUM was assessed and it was observed that this score is a reliable predictor for determining the quality of care given to a patient to avoid post-operative complications that might lead to increased morbidity and mortality. [ 23 ]…”

The Effect of Goal-directed Fluid Management based on Stroke Volume Variation on ICU Length of Stay in Elderly Patients Undergoing Elective Craniotomy: A Randomized Controlled Trial

“…A P-POSSUM score was also calculated and recorded to determine the operative risk for each subject. 22 The Edmonton frail scale was also recorded. 23 (The detailed description regarding P-POSSUM score and Edmonton frail scale are available in the supplemental digital content 1 and 2).…”