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Kim, Ahn, Kwon, Jung, Ahn, Heo, Hwang, and Chung: Validation of POSSUM-physiological Score as Predictors of Post-operative Morbidity and Mortality after Emergency Operation for Peptic Ulcer Complications
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(6): 391-398.

Published online: 4 December 2009

DOI: https://doi.org/10.4174/jkss.2009.77.6.391

Validation of POSSUM-physiological Score as Predictors of Post-operative Morbidity and Mortality after Emergency Operation for Peptic Ulcer Complications

Hong Beom Kim, M.D., Hye Seong Ahn, M.D.1, Jun Sik Kwon, M.D., In Mok Jung, M.D., Ph.D.1, Young Joon Ahn, M.D., Ph.D.1, Seung Chul Heo, M.D., Ph.D.1, Ki-Tae Hwang, M.D., Ph.D.1, Jung Kee Chung, M.D., Ph.D.1

Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

1Department of Surgery, Seoul National University Boramae Hospital, Seoul, Korea.

Corresponding author (jkchung@brm.co.kr)

Received 6 August 2009       Accepted 30 September 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

The POSSUM (Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity) score was developed to predict post-operative mortality and morbidity rates. The aim of this study was to validate the POSSUM physiologic score (POSSUM-P) in emergent operations for peptic ulcer complications.

Methods

We retrospectively collected data on patients who underwent emergent operation for peptic ulcer complications at Boramae Hospital between January 2003 and April 2009. The data included patients' characteristics (underlying disease, medication, duration of symptoms), operative characteristics (operation method, morbidity, and mortality) and the items for the POSSUM-P (basic information (age, sex, etc.), circulatory and respiratory signs, electrocardiogram, blood pressure, hemoglobin, white blood cell count, potassium level, sodium level, urea level and Glasgow coma scale). The POSSUM-P was calculated and compared according to the morbidity and mortality.

Results

One hundred and twelve patients were included. As for operation methods, primary repair (48.2%) was most common, followed by truncal vagotomy with pyloroplasty (27.7%). Thirty-seven patients had morbidities including wound infections (20), pneumonias (14), fluid collections (9), and so on. Eight patients died due to sepsis or pulmonary edema. The means of POSSUM-P were significantly different between patients with and without mortality (37.8 vs. 19.2, P<0.001) and between patients with and without morbidity (26.7 vs. 17.3, P<0.001). Those were different between patients with and without postoperative pneumonia and wound infection (P=0.002 and P=0.029, respectively).

Conclusion

The POSSUM physiologic score could help to predict the mortality or morbidity after emergency operation for complications of peptic ulcer disease, especially postoperative pneumonia or wound infection.

Keywords: POSSUM, Mortality, Morbidity, Peptic ulcer complications

Figures and Tables

Fig. 1
Hospital stay according to the POSSUM-phys score.
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Table 1
POSSUM-physiologic score
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*JVP = jugular venous pulse; †CXR = chest X-ray; ‡SOB = shortness of breath; §COAD = chronic obstructive airway disease; ∥WBC = white blood cell; ECG = electrocardiogram.

Table 2
POSSUM-operative severity score
jkss-77-391-i002

*Example of magnitude for general surgery: Minor = hernia, varicose vein, minor perianal surgery, scrotal surgery, minor transurethral resection of tumor, excision of large subcutaneous lesion; Intermediate = open cholecystectomy, laparoscopic cholecystectomy, appendectomy, excision of lesion requiring graft or minor excision, minor amputation, thyroid lobectomy; Major = laparotomy and small-bowel resection, colonic resection or anterior resection, major amputation, nonaortic vascular surgery, cholecystectomy and explorationof bile duct, total thyroidectomy; Major+ = Abdominoperineal excision of rectum, aortic surgery, Whipple resection, radical total gastrectomy.

Table 3
Patients' characteristics
jkss-77-391-i003

*NSAIDs = nonsteroidal antiinflammatory drugs; †DM = diabetes mellitus; ‡ESRD = end-stage renal disease; §ICU = intensive care unit.

Table 4
Type of operations
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*Abscess drain and jejunostomy, open drainage, percutaneous gastrostomy; †This type of operation was done because of uncontrolled bleeding from injured spleen.

Table 5
Relation between POSSUM-phys score and complication
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Table 6
Univariate & multivariate analysis of risk factors for postoperative complication
jkss-77-391-i006

*CI = confidence interval; †χ2 test; ‡NSAIDs = nonsteroidal antiinflammatory drugs; §Fisher's exact test; ∥DM = diabetes mellitus; ESRD = end-stage renal disease; **RA = rheumatoid arthritis; ††ICU = intensive care unit, ‡‡T-test.

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