Evaluation of POSSUM and P-POSSUM as predictors of mortality and morbidity in patients undergoing laparotomy at a referral hospital in Nairobi, Kenya
AbstractBackground The Physiological and Operative Severity Score for enUmeration of Morbidity and Mortality (POSSUM) and its Portsmouth modification (P-POSSUM) were developed for comparative audit in surgical patients. This study evaluated applicability of these systems in estimating mortality and morbidity risks in a cohort of patients undergoing laparotomy at the national referral hospital in Nairobi, Kenya. Methods Data of 166 patients undergoing laparotomy was subjected to POSSUM and P-POSSUM scoring systems and analyzed using linear and exponential methods. The discrimination power of POSSUM and P-POSSUM as predictors of surgical outcome was measured using the receiver–operating characteristic (ROC) curve. Results The overall observed to expected (O:E) ratio using linear analysis was 0.29:1 (POSSUM) and 0.67:1 (P-POSSUM) while exponential analysis gave an O:E of 0.2:1 (POSSUM) and 0.4:1 (P-POSSUM). The predicted morbidity using POSSUM was 1.09:1 (linear analysis) and 1:1 (exponential analysis). Hosmer–Lemeshow analysis did not show a significant lack of fit with the observed mortality when applied to POSSUM and P-POSSUM. The area under ROC curve was 0.74 (POSSUM) and 0.78 (P-POSSUM). Conclusion Our results support the suitability of P-POSSUM and POSSUM scoring systems to stratify morbidity and mortality risk in our study population.
Authors submitting articles to The Annals of African Surgery do so on the understanding that if accepted, they will retain the copyright and allow the journal to publish and archive the article under the CC BY (Creative Commons Attribution License) 4.0 International. See details on the Creative commons website. All authors will be required to sign an Author Agreement form detailing the agreement with the journal prior to the article being published. Download the form here
© 2019 Annals of African Surgery. This work is licensed under the Creative Commons Attribution 4.0 International License.