Comparison of P-Possum and Esas (Emergency Surgery Acuity Score) For Prediction of 30-Day Mortality in Patients Undergoing Emergency Laparotomy

Paras Ibn E Ali; Sohail  Ilyas; Sohaib  Ashraf; Hamayal  Zafar; Farwa  Kazmi; Ubaid Ullah  Siddiqui

doi:10.51253/pafmj.v75i1.10214

Authors

Paras Ibn E Ali Department of Surgery, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Sohail Ilyas Department of Surgery, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan
Sohaib Ashraf Department of Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Hamayal Zafar Department of Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Farwa Kazmi Department of Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ubaid Ullah Siddiqui Department of Surgery, Combined Military Hospital Quetta/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i1.10214

Keywords:

Emergencylaparotomy, Esas, P-Possum, Surgical mortality.

Abstract

Objective: To evaluate the validity of the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM) and Emergency Surgery Acuity Score (ESAS) scoring system and compare the positive predictive value of both in predicting 30 days’ mortality in patients undergoing emergency laparotomy.

Study Design: Prospective longitudinal study.

Place and Duration of Study: Department of Surgery and Department of Accident and Emergency, Combined Military Hospital Rawalpindi, Pakistan from Aug 2021 to Mar 2022.

Patients and methods: A total of 210 patients were enrolled in the study, with 30-day post-operative mortality as the primary outcome of interest. P-POSSUM and ESAS scores were calculated for all patients upon presentation to the surgical emergency. A cutoff of 19 for ESAS and 63 for P-POSSUM was used to predict 30-day post-operative mortality in emergency laparotomy patients.

Results: The observed mortality rate among the recruited patients was 9.5%. The mean age was 46.24±11.13 years, with 62.4% of the population being male. Among those who died within 30 days of follow-up, the majority were aged over 50 years (p=0.002) and predominantly male (p=0.460), with most having ileal or jejunal perforation. The AUROC for ESAS in predicting 30-day post-operative mortality was 0.974, while for P-POSSUM it was 0.885.

Conclusion: ESAS and P-POSSUM can both be employed in emergency surgical situations. As ESAS can be calculated pre-operatively, it should be preferred over P-POSSUM.

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