Mortality at Ibn sina surgical gastroenterology unit as predicted by possum with brief literature review

ABSTRACT

Failure to identify the high ris k factors for surgery and/or anesthesia is a serious medico-legal pitfall particularly if unexpected consequences ensue. Compare the mortality rate at Ibn Sina Surgical gastro-intestinal unit using POSSUM predicted mortality with the observed mortality. A prospective collection of data for patients admitted in 6-month period. Demographic data, symptoms, co-morbid illnesses, physical examination, results of investigations, operative findings were recorded as well as the follow up for one month. The data was fed to a POSSUM computer program to determine the predicted mortality. The univariate and multivariate analysis was done with SPSS. 252 patients were studied. They were 132 [52.4%] males. Mean [ +/- SD] age 49[ +/- 12.29] range 10-90 years. 216 [85.7%] patients underwent suigrey. The overall observed mortality was 32 [12.7%] patients. 10 [27.8%] patients died before surgery. The highest mortality was 9 [27.3%] in cases of carcinoma head of pancreas. Carcinoma of the stomach has observed mortality of 6 [42.9%] patients while its predicted mortality range from 1.7% to 35.7% with mean of 17.9%. Multivariate analysis showed that factors which have significant association with the observed mortality are the physiological score P 0.0001, age P 0.0001, predicted mortality P 0.0001 and inoperability P 0.0020. POSSUM has under-predicted mortality in gastric, oesophageal and cholangiocarcinoma. The out come of management of other types of cancer as oesophageal and colorectal cancer as well as the benign diseases of the gastrointestinal tract is consistent with the predicted values of the POSSUM. Therefore POSSUM is a good risk adjusted criteria for predicting mortality in GIT surgical diseases at Ibn Sina Hospital