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

October 09, 2007

Based on POSSUM, a system suggested by some British scholars more than 10 years ago, a team led by Dr. Lian-An Ding has established the M-POSSUM evaluation system with the aim of improving the accuracy and effectiveness of the original system.

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.
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Reference: World J Gastroenterol 2007 October 14; 13(38): 5090-5095 http://www.wjgnet.com/1007-9327/13/5090.asp

Correspondence to: Professor Dr. Lian-An Ding, Department of General Surgery, Affiliated Hospital of Medical School, Qingdao University, No 16 Jiangsu Road, Qingdao 266003, Qingdao City, Shandong Province, China Telephone: +86-532-82913050 Fax: +86-532-82913011

About World Journal of Gastroenterology

World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection for providing a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.



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