Evaluation of POSSUM scoring system in surgical decision making and audits

To test the validity of POSSUM scoring system as a surgical decision-making and audit tool by determining the association between actual deaths and POSSUM score predictions in a sample population of patients undergoing abdominal surgical procedures. Descriptive study. Combined Military Hospital, Rawalpindi, Pakistan from October 2007 to November 2008. POSSUM Score was calculated prospectively for all patients admitted to Surgical Ward I, CMH Rawalpindi, and scheduled to undergo laparotomy. Patients with previous history of surgery and day- surgery cases were excluded. Patients were stratified into three risk groups based on POSSUM Score, and 30 patients were picked randomly for the purpose of this study. The difference between observed deaths and the three risk groups was analysed for statistical significance by means of chi square test. A total of 90 patients were included in the study. All were males and above 12 years of age, with mean age 34. A significant association was observed between POSSUM Score and actual deaths [P<0.001]. Actual deaths increased with the rise in POSSUM Score. POSSUM was found to be a reliable scoring system which gives us an idea about mortality rate in general surgery patients with different physiological states. It shows great promise as an objective accessory to the process of making decisions about surgery in [high risk] patients. Also, it could be a valuable tool for use in surgical audits, providing a more accurate comparison between performances of various surgeons/ surgical teams

Vacuum assisted closure [VAC] therapy for difficult wound management

To show the usefulness of vacuum assisted closure [VAC] therapy for management of difficult wounds. Descriptive type of study. The study was conducted in the surgical dept of Combined Military Hospital Rawalpindi from September 2002 to February 2003. Fifty two patients were selected through non-probability convenient sampling. Age ranged from 12 years to 61 years. Out of 52 patients 22% were females while 78% were males. The commonest wound type was traumatic in 68%, diabetic ulcer in 15%, pressure ulcer in 8%, venous ulcer in 7% and radiation ulcers in 2%. The commonest location of wound was lower limb in 42%, foot in 30%, hand in 12%, abdomen in 9% and chest in 7%. Muscle and soft tissues comprised the largest group of wound bed 71%, tendon in 16%, bone in 7% and orthopedic implant in 6%. Out of 52 patients in the study 18% were smokers while 21% had diabetes mellitus. The reduction in wound size at the end of VAC therapy was 68.1%. Granulation tissue formed in 88% of wounds. Duration of VAC therapy ranged from 2 weeks to 5 weeks. The dressing changes ranged from 2 to 12 and mean was 5 dressing changes. Foam odour, pain in-growth of granulation tissue in foam and infection. Vacuum-assisted closure therapy promotes healing and the formation of healthy granulation tissue