Comparative study between P- POSSUM and Apache II scores in predicting outcomes of perforation peritonitis: Prospective observational cohort study.
Yelamanchi Raghav,Gupta Nikhil,Durga C K,Korpal Manit
International journal of surgery (London, England)
BACKGROUND:Scoring systems are needed to prognosticate, compare and audit surgical procedures. Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and morbidity (P-POSSUM) and Acute Physiological and Chronic Health Evaluation II (APACHE II) are well known and validated scores to predict surgical outcomes. The objective of this study was to compare P-POSSUM and APACHE II scores in predicting morbidity and mortality of patients who underwent emergency surgery for perforation peritonitis. MATERIALS AND METHODS:A prospective single-center cohort study was conducted with a sample size of 56 patients of perforation peritonitis from November 2018 to March 2020. All patients were followed up prospectively for a period of 30 days to monitor the primary outcome variable mortality and secondary outcome variables such as wound infection, wound dehiscence, anastomotic leak, respiratory complications, Intensive Care Unit (ICU) stay and hospital stay. RESULTS:Mean age of patients was 37.1 years and 67.86% were males. Ileum was the most common site of perforation followed by the stomach. The most common post-operative complication was wound infection (71.43%) followed by respiratory complications (64.29%) and wound dehiscence (35.71%). ICU stay was required for a majority of patients (74.42%). The mean hospital stay was 8.93 days and the mortality rate was 23.21% in this study. P-POSSUM and APACHE II scores had a good association with mortality, post-operative wound dehiscence, respiratory complications, ICU stay and hospital stay. However, there was no statistical difference between the two scores in predicting the above outcomes. Post-operative wound infection and anastomotic leak had no association with P-POSSUM or APACHE II scores. CONCLUSION:As the APACHE II score is based only on preoperative parameters and is easier to calculate we recommend its use for patients of perforation peritonitis over the P-POSSUM score as both have similar predictability.