POSSUM (Physiological operative severity score for enumeration of mortality and morbidity) is a simple scoring system, described and validated in developed countries like UK. Application of POSSUM to developing countries, with a different population and level of resources is limited. A total of 150 emergency laparotomies were performed. The risk of complication and death was calculated using POSSUM. The estimated rates were compared with observed rates using both linear and exponential methods of analysis. POSSUM over predicted complication when linear method is used i.e. 103 patients against 75 patients with complications O:E ratio of 0.72. When exponential method is used, it predicted near similar values 67 patients against 75 patients observed with O:E ratio of 1.11 with no significant difference. A total of 19 deaths observed. POSSUM with linear method of analysis over predicted deaths (37 patients) with O:E ratio of 0.51, whereas with exponential method it calculated similar number of deaths (20 patients) with O:E ratio of 0.95 with no significant difference.