Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity scoring system in general surgical practice and identifying risk factors for low outcome

Abstract

Background and Objectives: Scoring system in all areas of medicine is receiving close attention because of the need to evaluate and monitor healthcare delivery and outcomes. The main application is in comparative surgical audit to monitor quality of care provided to the patient with a risk adjusted scoring system rather than using crude morbidity and mortality rates. In this prospective study, the validity of P-POSSUM is tested in patients undergoing major surgery and risk factors for low outcome were noted. Materials and Methods: A total of 277 major general surgical procedures as defined by the POSSUM scoring system criteria were included in the study during the period from September 2010 to February 2012, and final analysis was done. Results: The observed mortality rate was compared with the P-POSSUM predicted mortality rate. On using P-POSSUM the predicted mortality was 37 deaths. An O: P ratio of 0.91 was obtained. There was found to be no statistically significant difference between the observed and predicted mortality rates (χ2 = 7.859, DF = 5, P -value = 0.164). On analysing risk-factors we found that out of the 17 factors considered 10 are found to have significant rate of increment, whereas remaining 7 don't have significant change statistically. Conclusion: This study therefore, validates P-POSSUM as a valid means of assessing adequacy of care provided to the patient.