Prognostic Value of P-POSSUM and Osteopenia for Predicting Mortality After Emergency Laparotomy in Geriatric Patients

Objective: to evaluate the portsmouth-physiological and operative severity score for the enumeration of mortality and morbidity (p-possum) in comparison with other risk factors for mortality including osteopenia as an indicator for frailty in geriatric patients subjected to emergency laparotomy. methods: all geriatric patients (≥65 years) undergoing emergency laparotomy at a single university hospital between 1/2015 and 12/2016 were included in this cohort study. demographics and outcomes were retrospectively collected from medical records. association between prognostic markers and 30-day mortality was assessed using poisson and backward stepwise regression models. prognostic value was assessed using receiver operating characteristic (roc) curves. results: 209 patients were included with a mean age of 76 ± 7.3 years. american society of anesthesiologists (asa) classification, age, indication and type of surgery, hypotension, transfusion requirement and current malignancy proved to be statistically significant predictors of 30-day mortality. p-possum mortality was statistically significant in the backward stepwise regression (incidence rate ratio=1.58, 95% ci: 1.16–2.15, p=0.004) while osteopenia was not. p-possum had poor prognostic value for 30-day mortality with an area under the roc curve (auc) of 0.59. the prognostic value of p-possum improved significantly when adjusting for patient covariates (auc=0.83). conclusion: p-possum and osteopenia alone hardly predict 30-day mortality in geriatric patients following emergency laparotomy. p-possum adjusted for other patient covariates improves the prediction.