POSSUM

(Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity)

Age

Glasgow (Help)

Respiratory

Urea

Pulse (beats/min)

Cardiac signs

Hb (g/dL)

W.B.C.

ECG

Potassium (mEql/L)

Sodium (mEql/L)

Systolic Blood Pressure

Physiologic Score

Operative Severity (help)	Multiple procedures	Total Blood Loss
Peritoneal soiling	Cancer	Mode of surgery
Operative Score

Predicted Morbidity Rate
(Definitions are following)
Predicted Mortality Rate

x = (0.16* physiologic score)+(0.19*operative score)- 5.91
Predicted Morbidity Rate = 1/(1+ e⁽^-x⁾)

y = (0.13* physiologic score)+(0.16*operative score)-7.04
Predicted Mortality Rate = 1/(1+ e⁽^-y⁾)

Ref : Copeland GP et al. POSSUM : a scoring system for surgical audit. Br J Surg. 1991;78: 356-60.

Morbidity : definitions

Wound haemorrhage : local haematoma requiring evacuation.
Deep haemorrhage: postoperative bleeding requiring re-exploration.
Chest infection: production of purulent sputum with positive bacteriological cultures, with or without chest radiography changes or pyrexia, or consolidation seen on chest radiograph.
Wound infection : wound cellulitis or the discharge of purulent exsudate.
Urinary infection: the presence of > 10 ⁵ bacteria / ml with the presence of withe cells in the urine, in previously clear urine.
Deep infection: the presence of an intra-abdominal collection confirmed clinically or radiologically.
Septicaemia : positive blood culture.
Pyrexia of unknown origin : any temperature above 37° C for more than 24 h occuring after the original pyrexia following surgery (if present) had settled , for which no obvious cause could be found.
Wound dehiscence : superficial or deep wound breakdown.
Deep venous thrombosis and pulmonary embolus : when suspected, confirmed radiologically by venography or ventilation/ perfusion scanning or diagnosed at post mortem.
Cardiac failure : symptoms or signs of left ventricular or congestive cardiac failure ( alteration from preoperative measures)
Impaired renal function : arbitrarily defined as an increase in blood urea of > 5 mmol / l from preoperative levels .
Hypotension : a fall in systolic blood pressure below 90 mmHg for more than 2 H as determined by sphygmomanometry or arterial pressure transducer measurement
Respiratory failure : respiratory difficulty requiring emergency ventilation.
Anastomotic leak : discharge of bowel content via the drain, wound or abnormal orifice.

Web page by : Jean-Yves Marandon Centre Chirurgical Marie Lannelongue (France)

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Moderate surgery : cholecystectomy, appendicectomy, mastectomy, transurethral resection of prostate
Major surgery : any laparotomy , bowel resection, cholecystectomy with choledochotomy, peripheral vascular procedure or major amputation
Major surgery + : any aortic procedure, abdominoperineal resection, pancreatic or liver resection, oesophagogastrectomy.

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Eyes Open	Verbal	Motor
Spontaneous To speech To pain Absent	Converses / Oriented Converses / Disoriented Inappropriate Incomprehensible Absent	Obeys Localizes pain Withdraws (flexion) Decorticate (flexion) rigidity Decerebrate (extension) rigidity Absent

Predicted Morbidity Rate (Definitions are following)	Predicted Mortality Rate
x = (0.16* physiologic score)+(0.19operative score)- 5.91 Predicted Morbidity Rate = 1/(1+ e⁽^-x*⁾)	y = (0.13* physiologic score)+(0.16operative score)-7.04 Predicted Mortality Rate = 1/(1+ e⁽^-y*⁾)