Applied Research Of Reformed POSSUM Scoring Combined With Clavien-Dindo Classification In Predicting The Incidence Of Severe Complications After Thoracoscopic Lung Surgery

Objective: To evaluate the value of applying reformed POSSUM scoring system combined with Clavien-Dindo Classification in predicting the incidence of severe complications after undergoing thoracoscopic lung surgery and to provide a quantitative basis for clinical decision-making and improvement of preoperative physiological status.Methods: The POSSUM scoring system was improved.The original indicators with minor effects on surgery were excluded with new indicators with greater impact being included,and a new scoring system was established.From Jan.2016 to Dec.2016,315 patients who had undergone thoracoscopic lung surgery in the Thoracic Surgery Department of Fourth Hospital of Hebei Medical University were selected.Their preoperative examinations and intraoperative data were summarized.POSSUM and reformed POSSUM were used for scoring,Clavien-Dindo for classification.Grade I was selected as non-severe complication group and Grade II~V as the severe complication groups.The number of complications was predicted by POSSUM and reformed POSSUM compared with the number of actual severe complications,and the prediction ratio of the two groups’ scoring were compared.Results: A total of 167 cases of complications occurred in 315 patients.Among them,disease with most complications was hydropneumothorax with71 cases,followed by 49 cases of pneumonia,13 arrhythmia,19 fever(excluding postoperative absorption fever),2 respiratory failure,1 incision infection,6 pulmonary atelectasis,1 empyema,1 heart failure,3 postoperative hemorrhage,and 1 cerebral infarction.No record for death was shown within30 days after surgery.The number of patients with complications accounted for 44.1%(139/315).Using the Clavien-Dindo Classification,complicationswith grade I,II,III,IV and above accounted for 22.5%,11.1%,9.8%,and0.6% respectively.There were 68 cases of severe complications and 71non-severe complications,accounting for 21.6% and 22.5% respectively.Logistic regression analysis showed that FEVI%,operation time and BMI served as independent influencing factors for postoperative complications.The prediction equation of the reformed POSSUM scoring system was:ln(R/1-R)=-11.727+(0.339×PS)+(0.304×OS)with R representing the incidence rate of postoperative complications.Both POSSUM and reformed scoring system had predictive effects on postoperative complications,with the latter bearing better predictive value than the original.Conclusion: 1.Clavien-Dindo Classification system combined with reformed POSSUM scoring could accurately predict the incidence of severe complications after undergoing thoracoscopic lung surgery.2.The sensitivity and specificity of the reformed POSSUM scoring were both higher than that of the POSSUM scoring with more accurate prediction on postoperative complications of VATS lung surgery.3.New prediction equation ln(R/1-R)=-11.727+(0.339×PS)+(0.304×OS)was obtained with R representing the incidence rate of postoperative complications.When the calculated complication rate was greater than 16.5%,patients had higher complication rate.4.Multivariate logistic regression analysis of the clinical data of patients undergoing VATS lung surgery revealed that FEV1%,operation time and BMI served as independent influencing factors for postoperative complications of pulmonary surgery.