ASSESSMENT OF MORBIDITY AND MORTALITY IN EMERGENCY LAPAROTOMY: A COMPARATIVE STUDY OF POSSUM AND PORTSMOUTH-POSSUM SCORING SYSTEMS

Abstract

Objective: To evaluate the diagnostic performance of the Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) and Portsmouth-POSSUM (P-POSSUM) for predicting postoperative morbidity and mortality following emergency laparotomy. Methodology: This prospective observational study was conducted in the Department of General Surgery, Dow University Hospital, Karachi, from 1st October 2025 to 30th May 2026. One hundred and fifty patients undergoing emergency laparotomy were enrolled. The physiological and operative parameters were recorded using the POSSUM scoring system. The patients were followed-up for 30 days postoperatively. Diagnostic performance was assessed using Area under Curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The mean age was 54.55±15.41 years. Observed morbidity was 34.9% and mortality was 9.2%. The POSSUM model demonstrated poor discrimination of morbidity (AUC = 0.523) and moderate discrimination of mortality (AUC = 0.711). P-POSSUM showed better discrimination for mortality (AUC = 0.714). At the optimal cutoff, POSSUM demonstrated a high sensitivity (88.7%) but a low specificity (14.1 %) for predicting morbidity but a low sensitivity (21.4%) and a high specificity (92.5%). Similar to POSSUM score, P-POSSUM also demonstrated a low sensitivity (50%) and high specificity (96.4%). Conclusion: The P-POSSUM showed slightly better predictive performance with higher specificity for a 30 day mortality than POSSUM. However, neither model achieved sufficient overall performance to support use as a standalone risk assessment tool in patients undergoing emergency laparotomy.