Clinical Research
Copyright ©2007 Baishideng Publishing Group Co.
World J Gastroenterol. Oct 14, 2007; 13(38): 5090-5095
Published online Oct 14, 2007. doi: 10.3748/wjg.v13.i38.5090
Table 1 General clinical profile of patients studied
Clinic dataPostoperativecomplicationsPostoperativedeathPostoperativecomplications
No.8416172
Age (yr)50-7950-7950-79
Average age68.67 ± 12.4759.64 ± 13.4869.82 ± 7.98
Gender (Male/Female)55/2911/5109/63
Diagnosis, n (%)
Malignancy76 (90.5)12 (75.0)162 (94.2)
Benign8 (9.5)4 (25.0)10 (5.8)
Concomitant diseases, n (%)
Yes14 (16.7)1 (6.3)68 (39.5)
No70 (83.3)15 (93.7)104 (60.5)
Table 2 Relative risk of all factors
FactorsSuffered complications
Died
RRPRRP
Age (yr) > 600.6810.3560.2110.008
> 702.1810.0050.3910.091
> 801.4690.3560.5490.569
Abnormal circulation system2.0740.0141.0920.869
ECG mild change0.8930.2740.3740.933
ECG ST-T change3.8170.0311.9280.418
Abnormal respiratory system3.5810.0001.7230.311
Liver function3.4380.00016.0070.000
Blood system2.6100.0002.7350.070
Renal function4.3330.04215.6670.000
Gastrointestinal diseases15.5450.0115.5710.046
Endocrine system2.3740.0021.6150.359
Nutrition4.9380.0006.0000.003
Central nervous system1.4920.5063.2860.148
Operation time > 2 h1.0970.0960.0280.112
Operation time > 4 h3.5410.0132.5490.093
Operative hemorrhage > 300 mL0.7830.3060.4810.216
Operative hemorrhage > 500 mL2.3470.0073.3920.027
Palliative excision of malignant tumor0.6930.0472.0140.082
Malignant tumor can’t excise7.1390.0005.1750.000
BP < 90/60 mmHg during operation5.4290.00013.1050.000
Steadyperioperative ECG monitoring7.7810.00016.0010.000
Table 3 M-POSSUM system
Index01234
Age (yr)< 6060-6970-79≥ 80
Circulatory systemNormal Car Fun, BP, ECGCar fun grade I, mild HP and abnormal ECG, sinoatrial bradycardia/tachycardia, low valtage of limb lead, BBBCar fun grade II, Mod. HP, well controlled by med, occasional atrial premature beatsCar fun grade III, myocardial infarct < 3 mon, mod HP by med, ectopic, arythm, ST-T change, artrial fibrillationSerious car, insuf, AHF, mal HP
Respiratory systemNormalLong history of smoking, CB, asthma, URI, thick pulmonary markingsMild COPD, mild PF change, mild pneumoMod COPD, Mod to serious abnormal PFRespiratory failure
Liver functionNormalHistory of hepatitis/cirrhosis of liver, TB < 34.2 μmol/LTB 34.2-51.3 μmol/LTB > 51.3 μmol/L
Renal functionNormalBUN ≤ 10.1 mmol/L, Cr ≤ 170 μmol/LBUN 10.1-15 mmol/L, Cr 170-300 μmol/LRenal failure need dialysis
Gastrointestinal tractNormalHistory of chronic gastroenteritis, controlled peptic ulcerActive gastrointestinal diseases(hemorrhage/ perforation of ulcers, active Crohn’s diseasePercutaneous intestinal fistulaShort bowel syndrome, transplantation of small bowels
Blood systemNormalPLT/WBC decreased mildly, Hb (rectified) > 85 g/LHematopathy as stable leukemia, WBC ≥ 14.5 × 109/LAplastic anemia, hypersplenism syndrome, leukemia etc.
Endocrine systemNormalMild increased BG, UGLu (-), treated hyperthyroidism, hypothyroidism, acromegaly, gout, rheumatoid diseaseMild increased BG, UGLu (+ - + +), and controlled DM, by oral medicine, hormonotherapy, active goutDM, astable with oral medicineDiabetic nephropathy
Nutritional Status2NormalSlight 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/chemotherapyCachexia
GCS1512-149-11 ≤ 8
Operative woundMino (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 tumorM Major++ (excision > 3 organs) /Mal tumor can’t excise
Anesthesia courseArrhythmia/low BP < 1/2 hcontinual low BP/ cardio-pulmonary resuscitation
Table 4 M-POSSUM in all groups of patients
GroupnM-POSSUMt-test
tP
No complication1726.51 ± 2.22-13.7230.000
Complication8411.04 ± 2.95
Alive2407.58 ± 2.83-9.0960.000
Dead1614.25 ± 3.02
Alive with complication6810.28 ± 2.38-5.6930.000
Table 5 Area under ROC curves predicting morbidity and mortality
VariatyAreaSDP
M-POSSUM (predicting for morbidity)0.9010.0200.000
M-POSSUM (predicting for mortality)0.9550.0160.000