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Assessment of P-POSSUM scores for emergency laparotomies at a district general hospital.

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Aim:

To assess if P-POSSUM scores accurately predict mortality for patients undergoing emergency laparotomy in our institution.

Introduction:

The national emergency laparotomy audit (NELA) uses P-POSSUM as a predictor of risk for patients undergoing emergency laparotomy and has used these scores to shape their guidelines (1). However the P-POSSUM score itself is not always an accurate representation of a patient’s likely mortality (2) and should only be used as a guideline when deciding whether to operate.

Methodology:

The NELA database was used to identify all patients undergoing an emergency laparotomy over a 3 month period. The demographics, indication for surgery, and pre and post op P-POSUM mortality rates were identified and compared to the actual mortality rate for these patients.

Conclusion:

 

For patients with a predicted mortality rate over 15%, we now have an MDT discussion between consultant surgeon, intensivist and anaesthetist.  Whilst our findings show that P-POSSUM gives an accurate predictor of mortality in our cohort, caution must be exercised when using it on an individual basis as many patients with a high score survive.

 

A holistic clinical approach must be considered when deciding to operate or not, not just a number. 

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