Prediction of Postoperative Mortality and Morbidity Using Possum Scoring System in Abdominal Emergencies of the Aged

Seigou Hoshina, Kazuo Takemura^*, Masaki Nagaya, Akio Yamada, Katsuya Akashi and Susumu Yamaguchi^*

Department of Emergency and Critical Care Medicine and Digestive Surgery^*, Saint Marianna University, School of Medicine

Background: With older people now living longer, emergency surgery among the elderly is rising. Indications for surgery remain controversial, however, especially in the very ill. We retrospectively evaluated emergency abdominal surgical risk and outcome in the elderly using POSSUM and APACHE II scoring. Subjects and Methods: Subjects were consisted of 102,384 patients treated at a university hospital emergency department between 1996 and 2000. Of these, 65 were elde-rly patients aged from 70 to 91 years old, undergoing emergency surgery for abdomen. Results: Preoperative Physiologyical POSSUM scores were significantly higher among nonsurvivors than survivors, i.e., 30.9+10.0 vs. 24.3+5.7 (p<0.01). Postoperative morbidity in patients developing complications was significantly higher than among those without complications, i.e., 0.73+0.22 vs. 0.55+0.22 (p<0.01). Preoperative APACHE II scores among survivors were 10.4+5.7 and postoperative scores 9.3+3.9, showing a statistically significant decrease (p<0.03). In nonsurvivors, however, APACHE II scores tended to increase. No significance was observed in preoperative APACHE II scores between survivors and nonsurvivors. Conclusion: POSSUM scoring is useful in determining the need for surgery in abdominal emergencies and predicting mortality and morbidity in the elderly.

Key words
The aged, abdominal surgical emergency, POSSUM score, APACHE II score

Reprint requests
Seigou Hoshina Department of Emergency and Critical Care Medicine, Saint Marianna University, School of Medicine 2-16-1 Sugao, Kiyamae-ku, Kawasaki, 216-8511 JAPAN

Accepted
March 26, 2003

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