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. 2019 Aug 26;7(16):2227-2237.
doi: 10.12998/wjcc.v7.i16.2227.

Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy

Deb Sanjay Nag  1 , Ankur Dembla  2 , Pratap Rudra Mahanty  3 , Shashi Kant  3 , Abhishek Chatterjee  3 , Devi Prasad Samaddar  3 , Parul Chugh  4
Affiliations

Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy

Deb Sanjay Nag et al. World J Clin Cases. .

Abstract

Background: Laparotomy remains one of the commonest emergency surgical procedures. Early prognostic evaluation would aid in selecting the high-risk patients for an aggressive treatment. Awareness about risks could potentially contribute to the quality of perioperative care and optimum utilization of resources. Portsmouth modification of Physiological and operative severity for the enumeration of mortality and morbidity (P-POSSUM) and the acute physiology and chronic health evaluation II (APACHE-II) have been the most widely used scoring systems for emergency laparotomies. It is always better to have a single scoring system to predict outcomes and audit healthcare organizations.

Aim: To compare the ability of APACHE-II and P-POSSUM to predict postoperative morbidity and mortality in patients undergoing emergency laparotomy.

Methods: All patients undergoing emergency laparotomy at the Tata Main Hospital, Jamshedpur between December 2013 and November 2014 were included in the study. In this observational study, P-POSSUM and APACHE-II scoring were done, and the outcome analysis evaluated with mortality being the primary outcome.

Results: For P-POSSUM, at a cut off value of 63 to predict mortality using receiver operating characteristics curve analysis, the area under the curve was 0.989; and for APACHE-II, at the cut off value of 24, the area under the curve was 0.965.

Conclusion: Because the ability of APACHE-II to predict mortality was similar to P-POSSUM and APACHE-II does not need scoring for intra-operative findings and histopathology reports, APACHE-II can be used pre-operatively to assess the risk in patients undergoing emergency laparotomy. However, for audit purposes, either of the two scoring systems can be used.

Keywords: Acute physiology and chronic health evaluation II; Emergencies; Laparotomy; Morbidity; Mortality.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Box-plots in Pearson correlation coefficient using APACHE-II. APACHE-II: Acute physiology and chronic health evaluation II.
Figure 2
Figure 2
Box-plots in Pearson correlation coefficient using P-POSSUM. P-POSSUM: Physiological and operative severity for the enumeration of mortality and morbidity.
Figure 3
Figure 3
Receiver operating characteristics curve for APACHE-II and P-POSSUM using the Multivariate logistic regression model. APACHE-II: Acute physiology and chronic health evaluation II; P-POSSUM: Physiological and operative severity for the enumeration of mortality and morbidity; ROC: Receiver operating characteristics curve.
See this image and copyright information in PMC

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