Comparison of risk assessment of scoring systems for outcome prediction in obstetrics and gynecological emergency laparotomies at Kigali University Teaching Hospital, Rwanda

Abstract

Objective: Surgical scoring systems have been widely used in medicine mainly to evaluate the severity of diseases and surgical emergency and potentially predict the outcome of those conditions during and after treatment. The purpose of this study vi was to evaluate the potential use of Possum and Apache II surgical scores in Obstetrical and gynecological emergency laparotomies at Kigali University Teaching Hospital, and to assess which one of the two systems would be superior at predicting the outcomes of those conditions in Obstetrical and gynecological surgical emergencies

Methods: A prospective cross-sectional study was performed from September 2019 to April 2020 for patients admitted for emergency explorative laparotomy in the Department of Obstetrics and Gynecology at KUTH. Data entry and data analysis were done using SPSS version 25. Two surgical scoring systems, Apache II and Possum were studied extensively to see their potential use in Ob/Gyn emergency laparotomies; and the two systems were compared with the aim of assessing which one of the two is superior at predicting the outcomes

Results: There were 178 patients admitted for emergency explorative laparotomies during the study period. Most of the patients (98.9%) were less than 45 years of age. Almost all (97.2%) had medical insurance. The majority of patients (92.7%) were from District Hospitals in the KUTH catchment area. More than a third of the patients were clinically unstable at the time of admission. In all interventions performed, Infections accounted for 57.9% of cases, and hemorrhage for 42.1%. The most common complication was the need for transfusion in 80.9% of cases. The mortality rate in the cohort was 8%. Patients who died had significantly higher APACHE II scores compared to survivors (16.5 versus 9.0, p<0.001). This was also seen with POSSUM scores (32.5 versus 22.0, p<0.001). There was no significant difference between either APACHE II or POSSUM scores between hemorrhagic or infectious cases. Participants who had APACHE II scores above 15 had a mortality of 42.8% and were 14.6 times more likely to die than those who scored less than 15 (95% CI: 4.4-48.4; p<0.001). The POSSUM did vii not perform as well. A score greater than 15 was not associated with significant mortality and a score > 30 was associated with 23.3% mortality.

Conclusion: While both increased APACHE II and POSSUM are associated with increased mortality in OBGYN emergency laparotomy, the APACHE II score was better in predicting mortality in our settings. The APACHE II score was better in predicting mortality in our settings. Comparing the sensitivity of the two scoring systems, APACHE II scoring system showed to be more sensitive for the outcome with less false positive rate compared to POSSUM scoring system.