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Comparison of POSSUM scoring and the Hardman Index in selection of patients for repair of ruptured abdominal aortic aneurysm. BJS 2003; 90: 421-425.

Published: 11th March 2003

Authors: W. D. Neary, P. Crow, C. Foy, D. Prytherch, B. P. Heather, J. J. Earnshaw et al.

Background

The aim was to assess to what extent the POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) and Hardman scoring systems were predictive of outcome after surgery for ruptured abdominal aortic aneurysm (RAAA).

Method

From January 1990 to December 2001, 232 patients presented with RAAA. Forty‐one were treated conservatively and all died; the remainder had emergency surgery. The case notes of all but three of these patients were reviewed retrospectively. POSSUM and Hardman scores were calculated and related to mortality.

Results

The mortality rate after emergency repair was 54 per cent (104 of 191). The physiology‐only POSSUM score specific for RAAA and the Hardman Index score were both significantly associated with increased mortality after operation (P < 0·001). Most non‐operated patients were in the highest risk bands.

Conclusion

Both POSSUM and Hardman scoring systems predicted outcome after emergency surgery for RAAA. The Hardman Index was simpler to calculate, but POSSUM identified a higher number of patients at risk. Risk scoring may help identify patients with RAAA for whom surgery is futile. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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