Comparative study between Portsmouth Physiological and Operative Severity Score for the Enumeration of mortality and morbidity (P-POSSUM) and the Acute Physiology and Chronic Health Evaluation (APACHE II) scores in predicting Mortality in patients of perforation peritonitis undergoing exploratory laparotomy in tertiary care centre in Eastern India

Perforation peritonitis is a common surgical emergency associated with significant morbidity and mortality. Early risk stratification using scoring systems such as Acute physiology and chronic health evaluation II (APACHE-II) and Portsmouth modification of Physiological and operative severity for the enumeration of mortality and morbidity (P-POSSUM) helps guide management and predict outcomes. This study aimed to compare the effectiveness of these scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy. This case series analysis included 89 patients with hollow viscus perforation undergoing emergency laparotomy at a tertiary care centre over 15 months. APACHE II scores were calculated within 24 hours of admission, while P-POSSUM scores incorporated both physiological and operative parameters. Patients were followed for 30 days. Statistical analysis included Receiver Operating Characteristic (ROC) curve analysis to evaluate predictive accuracy. The most common aetiologies were acid peptic disease (24.7%), trauma (21.3%), and appendicular perforation (13.5%). The overall 30 days mortality was 6.7%. Both APACHE II and P-POSSUM scores were significantly higher among non-survivors (p < 0.05). APACHE II demonstrated excellent predictive accuracy area under the ROC curve (AUC) 0.948 with sensitivity 98.9% and specificity 79.5% at a cutoff > 9.5. P-POSSUM also showed excellent accuracy (AUC 0.939) with sensitivity 98.3% and specificity 83.1% at a cutoff > 46.7. Both APACHE II and P-POSSUM were reliable predictors of postoperative mortality. APACHE II showed slightly better sensitivity and ease of use, while P-POSSUM demonstrated higher specificity. Given comparable performance, APACHE II may be preferred for early risk stratification.