Comparative Analysis of APACHE II and P-POSSUM

Comparative Analysis of APACHE II and P-POSSUM Scoring Systems in Predicting Postoperative Mortality in Patients Undergoing Emergency Laparotomy

To compare APACHE II and P-POSSUM scoring system in emergency laparotomy.

Study Overview

• Status: Completed
• Conditions: External Causes of Morbidity and Mortality

Detailed Description

To compare APACHE II and P-POSSUM scoring system in predicting postoperative mortality in patients undergoing emergency laparotomy.

• Study Type: Observational
• Enrollment (Actual): 159

Contacts and Locations

Study Locations

• India
  • Jharkhand
    • Jamshedpur, Jharkhand, India, 831001
      • Tata Main Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients undergoing emergency laparotomy at Tata Main Hospital form 01st December 2013 to 30th November 2014 will be included in the study. All patients will be scored with APACHE II and P-POSSUM scoring systems on the day of surgery.The patients will be followed up till discharge, death or 30 days postoperatively.

Description

Inclusion Criteria:

• All patients above 18 years of age undergoing emergency laparotomy at Tata Main Hospital form 01st December 2013 to 30th November 2014 will be included in the study.

Exclusion Criteria:

• Patients willingly seeking referral to a different hospital

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Area Under the Receiver Operating Curve (ROC) as a Measure of the Accuracy of the APACHE II and P-POSSUM Scoring Systems to Predict Mortality	Participants will be followed for the duration of hospital stay (expected average of 30 days) and mortality was noted.All patients undergoing emergency laparotomy at Tata Main Hospital form 01st December 2013 to 30th November 2014 were included in the study. All patients were scored with APACHE II and P-POSSUM scoring systems on the day of surgery. Area under the curve (AUC) is used to measure the "size" of the prediction composed by the graphic display between the 'sensitivity' and the '1-specificity' relationship. AUC can range from 0.5 to 1.0 and a result of 1.0 indicates a perfect discriminatory ability. An AUC value > 0.8 is considered good, a range between 0.60-0.80 is considered as moderate, and an AUC value < 0.60 is regarded as poor. For APACHE-II, a cut off score of >/=24 was determined; for P-POSSUM, a cut off score of >/= 63 was determined.	30 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Length of Stay (LOS)	The mean duration of hospital stay or Length of Stay was recorded	30 days
Need for Postoperative Ventilator Support	Number of patients needing post-operative ventilatory support	30 days
Need for Post Operative Inotropic Support	Number of patients needing post-operative inotropic support	30 days
Cardiac Morbidity (AMI or Arrhythmias Needing Treatment)	Number of patients noted to have Cardiac morbidity: Acute myocardial infarction (AMI) or arrhythmias needing treatment	30 days
Number of Participants With Acute Kidney Injury (AKI)	Acute Kidney Injury (AKI) was diagnosed based on the Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group (2012) guidelines; Increase in Serum Creatinine (S. Cr) by ≥0.3 mg/dl (≥ 26.5 μmol/l) within 48 hours; OR; Increase in S. Cr to ≥1.5 times baseline, which is known or presumed to have occurred within prior 7 days; OR; Urine volume <0.5 ml/kg/h for 6 hours	30 days
Patients Needing Re-exploration	Number of patients needing return to the operation theater for surgery for the same pathology or any other complication arising out of the initial surgery	30 days

Collaborators and Investigators

• Sponsor: Tata Main Hospital
• Investigators: Principal Investigator: Ankur Dembla, DA, Tata Main Hospital, Jamshedpur, India

Publications and helpful links

General Publications

• Nag DS, Dembla A, Mahanty PR, Kant S, Chatterjee A, Samaddar DP, Chugh P. Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy. World J Clin Cases. 2019 Aug 26;7(16):2227-2237. doi: 10.12998/wjcc.v7.i16.2227.

Helpful Links

• Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy

Study record dates

Study Major Dates

• Study Start: December 1, 2013
• Primary Completion (Actual): November 1, 2014
• Study Completion (Actual): December 1, 2014

Study Registration Dates

• First Submitted: June 9, 2015
• First Submitted That Met QC Criteria: June 10, 2015
• First Posted (Estimate): June 15, 2015

Study Record Updates

• Last Update Posted (Actual): October 15, 2019
• Last Update Submitted That Met QC Criteria: October 6, 2019
• Last Verified: May 1, 2016

More Information

Terms related to this study

• Other Study ID Numbers: 201-26104-132-108296

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO