Eswaravaka Saikrishna, Suhrid Chirantan, Rao Bhavya, Prabhakar Sundaresh, Pandya Jayashri
Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND.
General Surgery, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, IND.
Cureus. 2024 Jul 30;16(7):e65733. doi: 10.7759/cureus.65733. eCollection 2024 Jul.
Introduction Ileal perforation due to typhoid is common in tropical countries, and the ensuing secondary peritonitis is treated by resuscitation and surgery. The Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) was developed to predict postoperative outcomes to overcome systemic obstacles in any healthcare setup and is considered fairly accurate. The Portsmouth-POSSUM (P-POSSUM) score was developed as a corrective scoring system for overestimations made by the POSSUM score vis-à-vis mortality. Our study aimed to examine the validity of these two scores in the postoperative prediction of surgical outcomes in patients with ileal perforation. Materials and methods An observational study involving 40 patients diagnosed with ileal perforations was undertaken over 18 months. The postoperative outcome for each patient was calculated as per the POSSUM and P-POSSUM parameters. Statistical analysis was done using SPSS (IBM Corp., Armonk, NY) and the results were tabulated. Results We found that age, gender, respiratory dysfunction, propensity for multiple surgeries, duration of surgery, co-morbidities, underlying malignancy, and systolic blood pressure played a significant role in determining postoperative outcomes. Haemoglobin, potassium, and urea levels were also found to be significantly associated with outcome. Cardiac signs, pulse, white blood cell count, Glasgow Coma Scale score, sodium, and electrocardiography, part of the physiological score parameters, were found to be insignificant in the prediction of postoperative outcomes. Among the intraoperative parameters, peritoneal soiling was found to be insignificant. Conclusion Some parameters inherent to POSSUM and P-POSSUM calculations appear to bear no statistical significance to the final score, highlighting that these need to be revisited and perhaps modified to further simplify the calculation. The POSSUM score is an excellent predictor of postoperative morbidity and mortality in ileal perforation patients but is of questionable reliability due to its tendency to overestimate them. P-POSSUM has a better predictive power of postoperative mortality by correcting POSSUM mortality overestimation.
伤寒导致的回肠穿孔在热带国家很常见，随之而来的继发性腹膜炎通过复苏和手术进行治疗。生理和手术严重程度评分系统（POSSUM）旨在预测术后结果，以克服任何医疗环境中的系统性障碍，且被认为相当准确。朴茨茅斯-POSSUM（P-POSSUM）评分是作为对POSSUM评分在死亡率方面高估情况的校正评分系统而开发的。我们的研究旨在检验这两种评分在回肠穿孔患者手术结果术后预测中的有效性。
在18个月内对40例诊断为回肠穿孔的患者进行了一项观察性研究。根据POSSUM和P-POSSUM参数计算每位患者的术后结果。使用SPSS（IBM公司，纽约州阿蒙克）进行统计分析，并将结果制成表格。
我们发现年龄、性别、呼吸功能障碍、多次手术倾向、手术持续时间、合并症、潜在恶性肿瘤和收缩压在确定术后结果方面起重要作用。还发现血红蛋白、钾和尿素水平与结果显著相关。作为生理评分参数一部分的心脏体征、脉搏、白细胞计数、格拉斯哥昏迷量表评分、钠和心电图在术后结果预测中被发现无显著意义。在术中参数中，发现腹腔污染无显著意义。
POSSUM和P-POSSUM计算中固有的一些参数似乎对最终评分没有统计学意义，这突出表明需要重新审视并可能修改这些参数以进一步简化计算。POSSUM评分是回肠穿孔患者术后发病率和死亡率的优秀预测指标，但由于其有高估的倾向，可靠性存疑。P-POSSUM通过校正POSSUM对死亡率的高估，对术后死亡率有更好的预测能力。
