Clinical Trials Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2019; 7(16): 2227-2237
Published online Aug 26, 2019. 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, Ankur Dembla, Pratap Rudra Mahanty, Shashi Kant, Abhishek Chatterjee, Devi Prasad Samaddar, Parul Chugh
Deb Sanjay Nag, Pratap Rudra Mahanty, Shashi Kant, Abhishek Chatterjee, Devi Prasad Samaddar, Department of Anaesthesiology and Critical Care, Tata Main Hospital, Jamshedpur 831001, India
Ankur Dembla, Department of Anaesthesiology and Critical Care, Darya Ram Hospital, Sonipat 131001, India
Parul Chugh, Department of Biomedical Statistics, Sir Ganga Ram Hospital, New Delhi 110060, India
Author contributions: Nag DS, Dembla A, Mahanty PR, and Chatterjee A planned and conducted of the study, scored the patients, and prepared and edited the manuscript; Kant S and Samaddar DP prepared manuscript, reviewed the literature, and analyzed the findings; Chugh P was involved in the study as a biomedical statistician and guided the plan of the study, determined appropriate sample size, and performed statistical analysis and interpretation.
Institutional review board statement: The observational study was approved by the Hospital Ethics Committee, Tata Main Hospital.
Clinical trial registration statement: The registration identification No. NCT02471612.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Deb Sanjay Nag, MBBS, MD (Gold Medalist), Senior Consultant, Department of Anaesthesiology, Tata Main Hospital, C Road West, Northern Town, Jamshedpur 831001, India. ds.nag@tatasteel.com
Telephone: +91-943-1166582 Fax: +91-657-2224559
Received: February 22, 2019
Peer-review started: February 24, 2019
First decision: June 21, 2019
Revised: June 28, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 26, 2019
Processing time: 185 Days and 18.7 Hours
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: Laparotomy; Emergencies; Acute physiology and chronic health evaluation II; Morbidity; Mortality

Core tip: 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. To date, no study with statistically significant sample size has compared them in predicting mortality in emergency laparotomies. P-POSSUM cannot be done for patients who are managed conservatively and can be scored only when histopathology reports are available. In this study, both P-POSSUM and APACHE-II were found to be equally accurate. Therefore, APACHE-II scoring system can be used as effectively as P-POSSUM with the added advantage that it can be used in the acute stratification of the patients into risk groups even before surgery.