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

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.