Tekkis et al developed a version of the POSSUM score for patients undergoing colorectal surgery. The authors are from Queen Alexandra Hospital in Portsmouth, King's College Hospital London, St. George's Hospital London and Princess of Wales Hospital in Bridgend, England.
Subscores:
(1) physiological score
(2) operative severity score
Parameters in the physiologic score:
(1) age in years
(2) cardiac failure
(3) systolic blood pressure in mm Hg
(4) heart rate in beats per minute
(5) serum urea in mmol/L
(6) hemoglobin in g/dL
Parameters for operative severity score:
(1) operative severity
(2) peritoneal soiling
(3) operative urgency
(4) cancer stage
Parameter |
Finding |
Points |
age in years |
<= 60 years |
1 |
|
61 to 70 years |
3 |
|
71 to 80 years |
4 |
|
>= 81 years |
8 |
cardiac failure |
none |
1 |
|
mild |
1 |
|
moderate |
2 |
|
severe |
3 |
systolic blood pressure |
< 90 mm Hg |
3 |
|
90 to 99 mm Hg |
2 |
|
100 to 170 mm Hg |
1 |
|
> 170 mm Hg |
2 |
heart rate |
< 40 beats per minute |
3 |
|
40 to 100 beats per minute |
1 |
|
101 to 120 beats per minute |
2 |
|
> 120 beats per minute |
3 |
serum urea |
<= 10.0 mmol/L |
1 |
|
10.1 to 15.0 mmol/L |
2 |
|
> 15.0 mmol/L |
3 |
hemoglobin |
< 10.0 g/dL |
3 |
|
10.0 to 12.9 g/dL |
2 |
|
13.0 to 16.0 g/dL |
1 |
|
16.1 to 18.0 g/dL |
2 |
|
> 18.0 g/dL |
3 |
physiological score =
= SUM(points for all 6 parameters)
Parameter |
Finding |
Points |
operative severity |
minor |
1 |
|
intermediate |
3 |
|
major |
4 |
|
complex major |
8 |
peritoneal soiling |
none |
1 |
|
serous fluid |
1 |
|
local pus |
2 |
|
free pus |
3 |
|
feces |
3 |
operative urgency |
elective |
1 |
|
urgent |
3 |
|
emergency |
8 |
cancer stage |
none |
1 |
|
Duke A |
1 |
|
Duke B |
1 |
|
Duke C |
2 |
|
Duke D |
3 |
where:
• Complex major surgery: abdominoperitoneal resection of rectum, anterior resection, subtotal or total colectomy with or without ileal pouch.
• Major surgery: laparotomy, small bowel resection, hemicolectomy, Hartmann's procedure.
operative severity score =
= SUM(points for all 6 parameters)
X =
= (0.338 * (physiological score)) + (0.308 (operative severity score)) - 9.167
risk of mortality =
= 1 / (1 + EXP((-1) * X))
Purpose: To evaluate a patient undergoing colorectal surgery using the colorectal POSSUM score of Tekkis et al.
Specialty: Critical Care, Emergency Medicine
Objective: risk factors, severity, prognosis, stage
ICD-10: C18, C19, C20, C21, K35-K38, K50-K52, K55-K63,