Monitoring of surgical outcome is increasingly important part of governance of surgical activity. The aim of the study. POSSUM scoring system was applied prospectively to determine how it performed in predicting morbidity and mortality in patients undergoing emergency laparotomy in our hospital, a group known to be at high risk of complications and death. Material and methods. A total of 100 cases of emergency laparotomies were studied in patients admitted in general surgery department during the period of May 2008 to August 2010. The study group consisted of the following cases. Duodenal perforation (37 cases), intestinal obstruction (27 cases), gastric perforation (8 cases), ileal perforation (8 cases), appendicular perforation (7 cases), blunt trauma (4 cases) and others (9 cases). They were scored using POSSUM scoring system. Physiological scoring was done at the time of admission and operative scoring was done intraoperatively. They were followed up for the first 30 day post operative period for any complications and the outcome was noted. The observed morbidity and mortality rates were compared with the POSSUM predicted morbidity and mortality rates. Results. 15 patients died (mortality rate of 15%). The POSSUM predicted mortality was 20 deaths. O:E ratio of 0.71 was obtained. There was no statistically significant difference between the observed and predicted mortality rates (χ2=1.72, p=0.974). 71 patients experienced complications. The POSSUM predicted morbidity was 61 patients. O:E ratio of 1.19 was obtained. There was no statistically significant difference between the observed and predicted morbidity rates (χ2=1.594, p=0.991). Conclusions. POSSUM scoring is an accurate predictor of mortality and morbidity following emergency laparotomy and is a valid means of assessing adequacy of care provided to the patient. POSSUM can be used for surgical audit to assess and improve the quality of surgical care and helps in better outcome to the patient
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