EVALUATION OF MORTALITY AND MORBIDITY IN EMERGENCY GASTROINTESTINAL SURGERY USING P-POSSUM SCORE IN SHEIKH ZAYED HOSPITAL
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Keywords
Emergency gastrointestinal surgery, Mortality prediction, P-POSSUM score, Predictive accuracy, Risk assessment, Surgical outcomes
Abstract
Background: Emergency gastrointestinal surgeries are high-risk procedures with significant morbidity and mortality rates.
Objective: To evaluate the mortality and morbidity in emergency gastrointestinal surgery using p-possum score in Sheikh Zayed Hospital.
Methods: A descriptive cross-sectional study was conducted at Surgical Oncology Unit-2 Shaikh Zayed Hospital, Lahore from January 2023 to September 2023. Study included 120 patients undergoing emergency gastrointestinal surgery. P-POSSUM scores were calculated for each participant, and predicted mortality and morbidity rates were compared with observed outcomes. The data were analyzed using SPSS software version 25.
Results: The study included a total of 120 participants, with 38 (31.7%) females and 82 (68.3%) males. The age of participants ranged from 13 to 78 years, with the majority falling in the 41-60 years age group (n=64, 53.3%). The mean age was 48.4 ± 15.36 years. Based on P-POSSUM score, the predicted mortality rate was 9.2%, while the observed mortality rate was 10.8%. The observed/expected (O/E) ratios were calculated for different risk categories. For mortality, the O/E ratios ranged from 0 to 1.87, with the highest ratio observed in the 30.1-40% risk category. The overall O/E mortality rate ratio was 1.18. Hosmer and Lemeshow test found no significant lack of fit between the observed and predicted mortality (p=0.429). Postoperative complications were observed among the study participants. The most common complications included wound infections (n=11, 22.4%), chest infections (n=10, 20.4%), and hypotension (n=7, 14.3%). Other complications included septicemia, wound dehiscence, and urinary tract infections (UTI), among others.
Conclusion: This study demonstrates that the P-POSSUM score is a reliable tool for predicting mortality in emergency gastrointestinal surgery in a Pakistani population, with an observed/expected mortality ratio of 1.18 and no significant lack of fit. However, the model's predictive accuracy for morbidity was less robust, indicating the need for further refinement.
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Usman Iqbal
Post Graduate Trainee Registrar General Surgery and Surgical Oncology Unit-2, Shaikh Zayed Hospital, Lahore
Muhammad Imran Anwar
Professor & HOD General Surgery and Surgical Oncology Unit-2 Shaikh Zayed Hospital, Lahore
Amir Jameel
Consultant General Surgery and Surgical Oncology Unit-2 Shaikh Zayed Hospital, Lahore