Comparison of APACHE II, P-POSSUM and SAPS II scoring systems in patients underwent planned laparotomies due to...

The first aim of this study was to discuss the factors affecting mortality rate in patients with severe intraabdominal sepsis treated with planned relaparotomy. The second aim was to compare APACHEE II, P-POSSUM and SAPS II scoring systems to allow identification of high-risk patients.

A series of 34 patients who had intra-abdominal sepsis and treated with planned relaparotomy between January 2009 and January 2012 were included the study. The source of the peritonitis, type and number of surgical procedures, number of planned relaparatomies, microbiology surveillance, total intensive care unit (ICU) and hospital stay duration, number of intubated days, morbidity and mortality were analyzed. APACHEE II, SAPS II, P-POSSUM scores and estimated mortality ranges at admission were compared.

The mean age was 46 (16-76 years) and 73.5 % (n=25) were male. A total of 119 operations and 50 surgical procedures were performed. The overall mortality rate was 20.6% (n=7). Complications developed in %53 (n=18) of the patients. Mortality was higher in upper GIS leaks (6/20 versus 1/14 patients). Areas under the curve calculated by ROC curve analysis for APACHE II, SAPS II and P-POSSUM were 0.958, 0.955 and 0.931, respectively. The highest values for sensitivity (100%) and specivity (85.2%) together were reached in APACHE II, when cut off value for it was set to 20.5. The SAPS II and P-POSSUM physiology scores were correlated with overall hospital stay (p=0.022 r=0.438 and p=0.001 r=0.609 respectively), but this correlation was not found for APACHEE II score (p=0.085 r=0.337). However, all three scoring systems provided clear estimation of ICU stay duration.

We suggest that, in secondary peritonitis patients reserved for planned relaparotomy, APACHE II is more reliable for prediction of mortality and P-POSSUM scoring system is more reliable for prediction of overall hospital stay duration.