Modified physiological and operative score for the enumeration of mortality and morbidity risk assessment model in general surgery

Table 1 General clinical profile of patients studied

Clinic data	Postoperativecomplications	Postoperativedeath	Postoperativecomplications
No.	84	16	172
Age (yr)	50-79	50-79	50-79
Average age	68.67 ± 12.47	59.64 ± 13.48	69.82 ± 7.98
Gender (Male/Female)	55/29	11/5	109/63
Diagnosis, n (%)
Malignancy	76 (90.5)	12 (75.0)	162 (94.2)
Benign	8 (9.5)	4 (25.0)	10 (5.8)
Concomitant diseases, n (%)
Yes	14 (16.7)	1 (6.3)	68 (39.5)
No	70 (83.3)	15 (93.7)	104 (60.5)

Table 2 Relative risk of all factors

Factors	Suffered complications		Died
	RR	P	RR	P
Age (yr) > 60	0.681	0.356	0.211	0.008
> 70	2.181	0.005	0.391	0.091
> 80	1.469	0.356	0.549	0.569
Abnormal circulation system	2.074	0.014	1.092	0.869
ECG mild change	0.893	0.274	0.374	0.933
ECG ST-T change	3.817	0.031	1.928	0.418
Abnormal respiratory system	3.581	0.000	1.723	0.311
Liver function	3.438	0.000	16.007	0.000
Blood system	2.610	0.000	2.735	0.070
Renal function	4.333	0.042	15.667	0.000
Gastrointestinal diseases	15.545	0.011	5.571	0.046
Endocrine system	2.374	0.002	1.615	0.359
Nutrition	4.938	0.000	6.000	0.003
Central nervous system	1.492	0.506	3.286	0.148
Operation time > 2 h	1.097	0.096	0.028	0.112
Operation time > 4 h	3.541	0.013	2.549	0.093
Operative hemorrhage > 300 mL	0.783	0.306	0.481	0.216
Operative hemorrhage > 500 mL	2.347	0.007	3.392	0.027
Palliative excision of malignant tumor	0.693	0.047	2.014	0.082
Malignant tumor can’t excise	7.139	0.000	5.175	0.000
BP < 90/60 mmHg during operation	5.429	0.000	13.105	0.000
Steadyperioperative ECG monitoring	7.781	0.000	16.001	0.000

Table 3 M-POSSUM system

Index	0	1	2	3	4
Age (yr)	< 60	60-69	70-79	≥ 80
Circulatory system	Normal Car Fun, BP, ECG	Car fun grade I, mild HP and abnormal ECG, sinoatrial bradycardia/tachycardia, low valtage of limb lead, BBB	Car fun grade II, Mod. HP, well controlled by med, occasional atrial premature beats	Car fun grade III, myocardial infarct < 3 mon, mod HP by med, ectopic, arythm, ST-T change, artrial fibrillation	Serious car, insuf, AHF, mal HP
Respiratory system	Normal	Long history of smoking, CB, asthma, URI, thick pulmonary markings	Mild COPD, mild PF change, mild pneumo	Mod COPD, Mod to serious abnormal PF	Respiratory failure
Liver function	Normal	History of hepatitis/cirrhosis of liver, TB < 34.2 μmol/L	TB 34.2-51.3 μmol/L	TB > 51.3 μmol/L
Renal function	Normal	BUN ≤ 10.1 mmol/L, Cr ≤ 170 μmol/L	BUN 10.1-15 mmol/L, Cr 170-300 μmol/L	Renal failure need dialysis
Gastrointestinal tract	Normal	History of chronic gastroenteritis, controlled peptic ulcer	Active gastrointestinal diseases(hemorrhage/ perforation of ulcers, active Crohn’s disease	Percutaneous intestinal fistula	Short bowel syndrome, transplantation of small bowels
Blood system	Normal	PLT/WBC decreased mildly, Hb (rectified) > 85 g/L	Hematopathy as stable leukemia, WBC ≥ 14.5 × 109/L	Aplastic anemia, hypersplenism syndrome, leukemia etc.
Endocrine system	Normal	Mild increased BG, UGLu (-), treated hyperthyroidism, hypothyroidism, acromegaly, gout, rheumatoid disease	Mild increased BG, UGLu (+ - + +), and controlled DM, by oral medicine, hormonotherapy, active gout	DM, astable with oral medicine	Diabetic nephropathy
Nutritional Status2	Normal	Slight malnutrition (albumin 30-35 g/L, weight decrease < 2.5 Kg/m)	Moderate malnutrition (albumin < 30 g/L, mass decrease 2.5-5 kg/m); Radiotherapy/chemotherapy	Cachexia
GCS	15	12-14	9-11	≤ 8
Operative wound		Mino (OPT < 2 h/ hemorrhage volume < 300 mL)	Mod (OPT 2-4 h/hemorrhage volume 300-500 mL)	Major (OPT > 4 h/hemorrhage volume > 500 mL)/Palliative excision of Mal tumor	M Major++ (excision > 3 organs) /Mal tumor can’t excise
Anesthesia course				Arrhythmia/low BP < 1/2 h	continual low BP/ cardio-pulmonary resuscitation

Nor: Normal; Car: Cardiac; Fun: Function; BP: Blood pressure; HP: Hypertension; BBB: Bundle branch block; ECG: Electrocardiagram; Insuf: Insufficiency; AHF: Acute heart failure; Mod: Moderate; Med: Medicine; Mon: Month; CB: Chronic bronchitis; URI: Upper respiratory infection; PF: Pulmonary function; TB: Total bilirubin; BG: Blood glucose; UGLu: Urine glucose; DM: Diabetes mellitus; OPT: Operation time; Hm: Hemorrhage; Mal: Malignant; GCS: Glasgow coma score. ¹Liver function consul bilirubin in Child-Pough;

²Nutritional status consider albumin.

Table 4 M-POSSUM in all groups of patients

Group	n	M-POSSUM	t-test
			t	P
No complication	172	6.51 ± 2.22	-13.723	0.000
Complication	84	11.04 ± 2.95
Alive	240	7.58 ± 2.83	-9.096	0.000
Dead	16	14.25 ± 3.02
Alive with complication	68	10.28 ± 2.38	-5.693	0.000

Table 5 Area under ROC curves predicting morbidity and mortality

Variaty	Area	SD	P
M-POSSUM (predicting for morbidity)	0.901	0.020	0.000
M-POSSUM (predicting for mortality)	0.955	0.016	0.000