Echara Mohan Lal, Singh Amit, Sharma Gunjan
Department of General Surgery, J.L.N Medical College, Ajmer, Rajasthan, India.
Niger J Surg. 2019 Jan-Jun;25(1):45-51. doi: 10.4103/njs.NJS_11_18.
Comparison of operative morbidity rates after emergency laparotomy between units may be misleading because it does not take into account the physiological variables of patients' conditions. Surgical risk scores have been created, and the most commonly used is the Physiological and Operative Severity Score for the enumeration of Mortality (POSSUM) or one of its modifications, the Portsmouth-POSSUM (P-POSSUM), usually requires intraoperative information.
The objective of this study is to evaluate the POSSUM and P-POSSUM scores in predicting postoperative morbidity and mortality in patients undergoing emergency laparotomy.
This is a prospective, cross-sectional, and hospital-based study that was conducted at J.L.N. Medical College and Hospital, Ajmer, Rajasthan, India, from April 2017 to December 2017. Adult patients who presented at the causality and underwent emergency laparotomy were included in the study. Observed and predicted mortality and morbidity were calculated using POSSUM and P-POSSUM equations, and statistical significance was calculated using Chi-square test.
A total of 100 patients were included in this study, with a mean age of 42.83 ± 18.21 years. The observed (O) mortality was 12 (12.0%), while POSSUM predicted 40 (40%) and P-POSSUM 27 (27%). The O/E ratio for POSSUM was 0.29 and for P-POSSUM was 0.44, and this means that they both overestimate mortality. When the results were tested by Chi-square test, the value was found to be 0.55 and 0.85 for POSSUM and P-POSSUM, respectively, which showed no significant correlation for observed and expected mortality. The observed morbidity was 69 (69%), while POSSUM expected morbidity was 79 (79%), O/E ratio is 0.87, and this again overestimates the morbidity. POSSUM is overpredicting the rate of morbidity, and test of correlation showed no significance with = 0.75.
POSSUM and P-POSSUM were found to overestimate mortality and morbidity in our patient's population.
各单位之间急诊剖腹手术后手术发病率的比较可能会产生误导，因为它没有考虑患者病情的生理变量。已经创建了手术风险评分，最常用的是用于计算死亡率的生理和手术严重程度评分（POSSUM）或其修改版本之一朴茨茅斯-POSSUM（P-POSSUM），通常需要术中信息。
本研究的目的是评估POSSUM和P-POSSUM评分在预测急诊剖腹手术患者术后发病率和死亡率方面的作用。
这是一项于2017年4月至2017年12月在印度拉贾斯坦邦阿杰梅尔市J.L.N.医学院和医院进行的前瞻性、横断面、基于医院的研究。纳入在急诊室就诊并接受急诊剖腹手术的成年患者。使用POSSUM和P-POSSUM方程计算观察到的和预测的死亡率及发病率，并使用卡方检验计算统计学意义。
本研究共纳入100例患者，平均年龄为42.83±18.21岁。观察到的（O）死亡率为12例（12.0%），而POSSUM预测为40例（40%），P-POSSUM预测为27例（27%）。POSSUM的O/E比为0.29，P-POSSUM的O/E比为0.44，这意味着它们都高估了死亡率。当通过卡方检验对结果进行检验时，POSSUM和P-POSSUM的 值分别为0.55和0.85，这表明观察到的和预期的死亡率之间无显著相关性。观察到的发病率为69例（69%），而POSSUM预期发病率为79例（79%），O/E比为0.87，这再次高估了发病率。POSSUM过度预测了发病率水平，相关性检验显示无显著性， 值为0.75。
在我们的患者群体中，发现POSSUM和P-POSSUM高估了死亡率和发病率。
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