Preoperative Score And Preoperative Intervention For High Risk Patients With Gastrointestinal Surgery

Objective To study the clinical significance and shortage of the operative risk assessment with modified physiological and operative severity score for the enumeration of mortality and morbidity (M-POSSUM) for patients with gastrointestinal surgery, and investigate the value of M-POSSUM in guiding preoperative intervention for patients with gastrointestinal surgery.Methods Ninety-six patients with gastrointestinal surgery were assessed by POSSUM, APACHEII and M-POSSUM scoring system in 24 hours after admission and on the first postoperative day. Their length of hospital stay and charges and postoperative complications and mortality rate were recorded. If the estimated complication incidence rate R value>0.5 with M-POSSUM, they were included into high risk group, otherwise, were included into control group. All the patients were divided into group with postoperative complications and group with non-complications. CRP(C-reactive protein) levels of 74 patients were measured in 24 hours after admission and the first postoperative day. Fifty-three patients undergone preoperative intervention were divided into two groups. The study group of 28 patients was given preoperative intervention with the guideline of M-POSSUM scores, the control group of 25 patients was given routine treatments before operation according to the clinician's experiences.Results The scores of the first postoperative day by three assessment systems were significantly higher than that calculated after admited to the ward with them(P<0.01), and they were all positive correlated. The POSSUM and M-POSSUM scores of the first postoperative day and the day when admision were both significantly positively correlated with the complications. The APACHEII scores after entrance to the ward were not correlated with the complications while the scores of the first postoperative day were significantly positively correlated with them. The M-POSSUM scores of the group with complications when admission were significantly higher than that with non-complications(P<0.01). There was no statistical difference between the complication cases prognosed by M-POSSUM just after entrance to the ward with that of the actual ones(P>0.05). There was statistical significance for the complication incidence prognosed by POSSUM just after entrance to the ward and the actual complication incidence(P<0.01). The complication cases prognosed by M-POSSUM and POSSUM just after entrance to the ward had statistical significance(P<0.01). There was no statistical difference between the actual complication incidence of the high risk group with that of the control group by POSSUM(P>0.05). The complication cases prognosed by M-POSSUM on admission and the actual postoperative complication cases of the high risk group had statistical significance (P<0.01). The complication incidence of the study group that given preoperative interventions under the guideline of M-POSSUM was much lower than that of the group given routine treatments according to clinican's experiences. There was significant statistical difference(P<0.01). The levels of CRP on the first postoperative day were significantly higher than that of the day pre-operation(P<0.01), there was statistical significant difference between them. CRP levels of just after entrance to the ward were significantly positively correlated with M-POSSUM scores of the same time(P<0.01). meanwhile, the levels of CRP of the first postoperative day were not correlated with M-POSSUM scores of the same time .Conclusion M-POSSUM scoring system may be applied to the estimation of operative risk for patients with gastrointestinal surgery. As to decrease the postoperative complications incidence, it has played an important role for the M-POSSUM scores before operation when hospitalized to the ward in guiding preoperative intervention. The levels of CRP in 24h after admission may be as a predictor of the operative risk for patients with gastrointestinal surgery.