An Analysis of the Short Term Outcomes of Laparotomy Among Surgeons in Mulago Hospital Using POSSUM Scoring System

Abstract

More than 600 laparotomy operations are conducted in Mulago National Referral Hospital (MNRH) every year. However, there are no criteria for judging the outcomes (morbidity and mortality) and comparing the short-term outcomes of these operations among surgeons in the Department of Surgery. The Physiological Operative Severity Score for the enumeration of Morbidity and Mortality (POSSUM) was used to analyze the short-term outcomes of laparotomy among surgeons in MNRH. A cross-sectional study was conducted using 76 consecutively recruited patients who underwent emergency and elective laparotomy. POSSUM scoring system was used and patients followed-up to 30th post-operative day. Day-care surgeries, patients who died on table before induction of anesthesia, and patients below 13 years of age were excluded from the study. Informed consent and assent was obtained from each patient before surgery and ethical approval was obtained from the research and review committee of Makerere University Medical School. There were 51 emergencies (67.1%) and 25 (32.9%) electives. 13 patients (17.1%) were operated by consultants, 8 (10.5%) by registrars and 55 (72.4%) by senior residents. Short-term outcome (morbidity) among the surgeons was: consultants (t= -0.081, p=0.243), registrars (t= -0.039, p=0.368), and senior residents (t= -0.041, p=0.362). Mortality outcomes for surgeons were consultants (t= -0.012, p=0.460), registrar (t=.-0.012, p=0.460) and senior residents (t= 0.087, p=0.228). POSSUM successfully analyzed the short-term outcomes of laparotomy among surgeons in MNRH. All the surgeons were performing well within the predictive power of Possum.