Modified Physiological and Operative Severity Score for Risk Assessment in Patient of Perforation Peritonitis

Aim: To establish a scoring system for predicting the incidence of postoperative complications and mortality in patients with perforation peritonitis based on the modified physiological and operative severity score for the enumeration of mortality and morbidity (M-POSSUM), and to evaluate its efficacy. Methods: Patients under study, were grouped as those with postoperative complications (n = 35) and those without postoperative complications (n = 35). The period of study was 12 months and the data was analysed retrospectively and prospectively for logistical regression. Patients with age less than 12 years were excluded. Modified POSSUM (M-POSSUM) was used and its efficacy evaluated. Fifteen indices were assessed as part of the scoring system such as age, cardiovascular function, respiratory function, blood test results, endocrine function, central nervous system function, hepatic function, renal function, nutritional status, extent of operative trauma, and course of anaesthesia. Results: Logistic regression analysis yielded statistically significant equations for both morbidity and mortality for comparison of both groups. The predictive accuracy of morbidity equation and mortality equation was 83.6% and 94.1%, respectively. Significant risk factors were found to be age, cardiovascular function, respiratory function, hepatic function, renal function, blood test results, endocrine function, nutritional status, duration of operation, intra-operative blood loss, and course of anaesthesia. These factors were all included in the scoring system. There was significant difference in the scores between the patients with and without postoperative complications, between the patients who died and those who survived with complications, and between the patients who died and those who survived without complications. Conclusion: Our study validates the main perioperative complications of surgery for perforation peritonitis and influencing and non-influencing risk factors, taking into account the scoring system, which are important to the surgeon and the relevant specialist as well. In order to minimize or even avoid complications it is crucial to know these risk factors and strategies to prevent treat or reduce intra- and postoperative complications.