Sreeharsha Harinatha, Sp Rai, Sreekar Harinatha, Reddy Ravi
Pol Przegl Chir. 2014 Apr;86(4):159-65. doi: 10.2478/pjs-2014-0029.
Monitoring of surgical outcome is increasingly important part of governance of surgical activity.
POSSUM scoring system was applied prospectively to determine how it performed in predicting morbidity and mortality in patients undergoing emergency laparotomy in our hospital, a group known to be at high risk of complications and death.
A total of 100 cases of emergency laparotomies were studied in patients admitted in general surgery department during the period of May 2008 to August 2010. The study group consisted of the following cases. Duodenal perforation (37 cases), intestinal obstruction (27 cases), gastric perforation (8 cases), ileal perforation (8 cases), appendicular perforation (7 cases), blunt trauma (4 cases) and others (9 cases). They were scored using POSSUM scoring system. Physiological scoring was done at the time of admission and operative scoring was done intraoperatively. They were followed up for the first 30 day post operative period for any complications and the outcome was noted. The observed morbidity and mortality rates were compared with the POSSUM predicted morbidity and mortality rates.
15 patients died (mortality rate of 15%). The POSSUM predicted mortality was 20 deaths. O:E ratio of 0.71 was obtained. There was no statistically significant difference between the observed and predicted mortality rates (χ²=1.72, p=0.974). 71 patients experienced complications. The POSSUM predicted morbidity was 61 patients. O:E ratio of 1.19 was obtained. There was no statistically significant difference between the observed and predicted morbidity rates (χ²=1.594, p=0.991).
POSSUM scoring is an accurate predictor of mortality and morbidity following emergency laparotomy and is a valid means of assessing adequacy of care provided to the patient. POSSUM can be used for surgical audit to assess and improve the quality of surgical care and helps in better outcome to the patient.
手术结果监测日益成为手术活动管理的重要组成部分。
前瞻性应用POSSUM评分系统，以确定其在预测我院接受急诊剖腹手术患者的发病率和死亡率方面的表现，该组患者已知并发症和死亡风险较高。
2008年5月至2010年8月期间，对普外科收治的100例急诊剖腹手术患者进行了研究。研究组包括以下病例。十二指肠穿孔（37例）、肠梗阻（27例）、胃穿孔（8例）、回肠穿孔（8例）、阑尾穿孔（7例）、钝性创伤（4例）及其他（9例）。使用POSSUM评分系统对他们进行评分。入院时进行生理评分，术中进行手术评分。术后对他们进行为期30天的随访，观察有无并发症并记录结果。将观察到的发病率和死亡率与POSSUM预测的发病率和死亡率进行比较。
15例患者死亡（死亡率为15%）。POSSUM预测死亡20例。得到的O:E比值为0.71。观察到的死亡率与预测的死亡率之间无统计学显著差异（χ²=1.72，p=0.974）。71例患者出现并发症。POSSUM预测并发症为61例。得到的O:E比值为1.19。观察到的发病率与预测的发病率之间无统计学显著差异（χ²=1.594，p=0.991）。
POSSUM评分是急诊剖腹手术后死亡率和发病率的准确预测指标，是评估为患者提供的护理是否充分的有效手段。POSSUM可用于手术审计，以评估和改善手术护理质量，并有助于患者获得更好的结果。
