Comparative Assessment of APACHE II, POSSUM, and Surgical Apgar Score for Predicting Morbidity and Mortality in Emergency Laparotomy Patients at KIMS Hospital, Bangalore (Code-T0141)

Introduction: Emergency laparotomy is a high-risk surgical procedure associated with significant morbidity and mortality. Accurate risk prediction models, such as APACHE II, POSSUM, and the Surgical Apgar Score (SAS), play a vital role in guiding clinical decisions and optimizing outcomes.

Aims and Objectives:

Aim:

To compare the accuracy of ‘Surgical APGAR’, ‘POSSUM’ and ‘APACHE-II’ scoring systems in predicting the risk of Mortality and Morbidity in patients undergoing Emergency Laparotomy at KIMS Hospital, Bangalore.

Objectives:

• To assess the validity of ‘Surgical Apgar Score’, ‘APACHE II score’ and ‘POSSUM score’ in predicting mortality and morbidity in patients undergoing Laparotomy in Emergency settings.
• To compare the efficiency of ‘Surgical Apgar score’, ‘APACHE II score’ and 'POSSUM score’ in Emergency Laparotomies.

Methods: A prospective observational study was conducted on patients undergoing emergency laparotomy over 12 months. Data were collected on demographics, clinical parameters, and surgical details. Risk scores were calculated for each model. Outcomes assessed included postoperative morbidity, mortality, and length of hospital stay. Statistical analyses evaluated the predictive accuracy of each scoring system using receiver operating characteristic (ROC) curves, sensitivity, and specificity.

Results: Among the study cohort, APACHE II demonstrated the highest predictive accuracy for mortality (AUC = 0.87), while POSSUM showed superior performance in predicting morbidity (AUC = 0.83). The SAS was effective for intraoperative risk stratification but had lower sensitivity for postoperative outcomes. APACHE II and POSSUM were better at distinguishing high-risk patients requiring intensive postoperative care.

Conclusion: APACHE II and POSSUM are robust tools for predicting morbidity and mortality in emergency laparotomy patients, with APACHE II excelling in mortality prediction. The SAS, while useful intraoperatively, requires supplementary measures for comprehensive risk assessment. Incorporating these models into clinical workflows may enhance perioperative management and patient outcomes.

Keywords: Emergency Laparotomy, APACHE II, POSSUM, Surgical Apgar Score, Risk Prediction, Morbidity and Mortality