POSSUM for Operative Morbidity and Mortality Risk
Estimates morbidity and mortality for general surgery patients.
INSTRUCTIONS
Use values at the time of surgery, not admission.
NOTE: The POSSUM should not be used for trauma patients.
When to Use
Pearls/Pitfalls
Why Use
Physiological score
years
No failure
Diuretic, digoxin or angina/hypertension meds
Peripheral edema, warfarin, or borderline cardiomegaly on chest X-ray (CXR)
Raised jugular venous pressure, or cardiomegaly on CXR
No dyspnea
Exertional dyspnea or mild COPD on CXR
Limiting dyspnea or moderate COPD on CXR
Dyspnea at rest or fibrosis/consolidation on CXR
mm Hg
beats/min
points
g/dL
× 10³ cells/µL
mg/dL
mEq/L
mEq/L
Normal
Atrial fibrillation (HR 60-90)
5 ectopic beats/min, Q waves or ST/T wave changes
Any other abnormal rhythm
Operative severity score
Minor
Moderate
Major
Major+
1
2
>2
mL
None
Minor (serous fluid)
Local pus
Free bowel content, pus or blood
None
Primary only
Lymph node mets
Distant mets
Elective
Emergency (within 24h), resuscitation >2h possible
Emergency (within 2h)
Result:
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