Comparative Analysis of APACHE II and P-POSSUM

Study Overview
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Brief Summary
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To compare APACHE II and P-POSSUM scoring system in emergency laparotomy.

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

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

Conditions
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External Causes of Morbidity and Mortality

Participation Criteria
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Eligibility Criteria
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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
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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What is the study measuring?
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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 |