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. 2025 Jan 31;40(1):e711.
doi: 10.5001/omj.2025.43. eCollection 2025 Jan.

Efficacy of POSSUM and P-POSSUM Scoring Systems in Predicting Outcomes of Emergency Gastrointestinal Surgeries

Akarsh Bullagan  1 , Atul Jain  1 , Suhas Agarwal  1 , Vaishali Saxena  1 , Tanweer Karim  1 , Sumit Chakravarti  1
Affiliations

Efficacy of POSSUM and P-POSSUM Scoring Systems in Predicting Outcomes of Emergency Gastrointestinal Surgeries

Akarsh Bullagan et al. Oman Med J. .

Abstract

Objectives: The aim of the study was to assess morbidity and mortality outcomes using the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) scores in patients undergoing emergency gastrointestinal surgeries, and to compare the capabilities of POSSUM and P-POSSUM models in predicting mortality and morbidity.

Methods: In this prospective observational study, participants were selected from patients undergoing emergency gastrointestinal surgery at our hospital. The physiological component of POSSUM and P-POSSUM scores was calculated preoperatively, while the operative component was determined intraoperatively.

Results: A total of 45 patients were included in the study, with a mean age of 37.9 ± 15.7 years. The male-female ratio was 1.5:1.0. Intestinal perforation was the most common diagnosis (15; 33.3%) that necessitated exploratory laparotomy. The cutoff of POSSUM morbidity score of 87.5% had a sensitivity of 83.3% and a specificity of 92.6%, while the cutoff P-POSSUM morbidity score of 88.6% yielded a sensitivity of 88.9% and a specificity of 96.3%. Regarding mortality prediction, the cutoff POSSUM mortality score of 56.7% had a sensitivity of 87.5% and a specificity of 94.6%, while a P-POSSUM mortality cutoff score of 22.7% had a sensitivity of 100% and a specificity of 81.1%.

Conclusions: Both POSSUM and P-POSSUM scores demonstrated significant sensitivity and specificity in predicting morbidity and mortality in patients undergoing emergency gastrointestinal surgeries. They can be effectively utilized for risk assessment in clinical practice.

Keywords: Gastrointestinal Tract; India; Outcome; Prediction; Risk Assessment; Score; Severity of Illness Index; Surgical Procedures, Operative.

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Figures

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Table 7: Diagnostic performance of POSSUM mortality prediction model, analyzed by AUROC (N = 45).
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Table 8: Diagnostic performance of P-POSSUM mortality prediction model, as analyzed by AUROC (N = 45).
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Table 9: Diagnostic performance of POSSUM morbidity prediction model, as revealed by AUROC (N = 45).
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Table 10: Diagnostic performance of P-POSSUM morbidity prediction model as revealed byAUROC (N = 45).
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