Abstract
This study was designed to clarify the prognostic factors and the usefulness of The Acute Physiology And Chronic Health Evaluation II (APACHE II) score, The Sequential Organ Failure Assessment (SOFA) score and The Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) score as the postoperative risk assessment in emergency surgery for patients with colorectal perforations. Fifty-six patients who underwent emergency surgery for colorectal perforations between September 2001 and September 2011 were compared for mortality using every scoring system. As the result, the postoperative mortality was 19.6% (n=11). There was no statistically significant difference in patients' backgrounds and surgical methods between non-survivors and survivors, however, every scoring system was a significant predictor of postoperative mortality in the patients with a colorectal perforation. The prognosis of patients was not improved after the introduction of PMX-DHP (direct hemoperfusion with polymyxin-B immobilized fiber) and/or CHDF (continuous hemodiafiltration), however, the APACHE II, SOFA, and POSSUM score in the cases which received PMX-DHP and/or CHDF were higher than the score in the cases who did not receive PMX-DHP and/or CHDF. It is concluded that the APACHE II, SOFA and POSSUM scores are a better predictor of postoperative mortality and are useful as indicators for the risk assessment in patients with colorectal perforations. PMX-DHP and/or CHDF therapy have limitations in patients with high APACHE II, SOFA, and POSSUM scores.
