M-POSSUM, an effective risk assessment system prior to operation

Numerous scoring systems currently exist for risk assessment, including the Glasgow Coma Scale (GCS), the Acute Physiology and Chronic Health Evaluation (APACHE), and the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM). These scoring systems are important tools in deciding the course of treatment.

The best known and most widely used scoring systems, APACHE and POSSUM, have limitations when applied to high-risk, general surgical patients. APACHE is best suited to intensive care patients, but requires 24 h of observation, and weighing tables for individual disease states. POSSUM, on the other hand, is limited by its somewhat subjective nature and incomplete evaluation of cardiac signs. They propose a modified POSSUM (M-POSSUM) as a reasonable, practical and objective scoring system that can be used across a broad disease spectrum in general surgery.

In contrast to APACHE and POSSUM, the present scoring system is based on GCS, APACHE, and POSSUM, and supplemented with the following indices: hepatic function (bilirubin), blood glucose level, gastrointestinal function and nutritional status (albumin). However, body temperature, heart rate, sodium and potassium, which are always normal preoperatively in general surgery, are not considered. To avoid repetition, the duration of operation, volume of intraoperative blood loss and surgery are considered as operative wound indices for a malignant tumor. M-POSSUM also takes blood pressure and electrocardiographic activity into consideration during anesthesia.

Through a study of a series of more than 200 patients, They show that M-POSSUM is more accurate than POSSUM and APACHE II in predicting postoperative morbidity and mortality. M-POSSUM therefore seems to be a better model for risk assessment. Further studies are now being carried out.