Ref : Copeland GP et al. POSSUM : a scoring system for surgical audit. Br J Surg. 1991;78: 356-60.
Morbidity : definitions
Wound haemorrhage : local haematoma
requiring evacuation.
Deep haemorrhage: postoperative bleeding requiring
re-exploration.
Chest infection: production of purulent sputum with positive
bacteriological cultures, with or without chest radiography changes
or pyrexia, or consolidation seen on chest radiograph.
Wound infection : wound cellulitis or the discharge of
purulent exsudate.
Urinary infection: the presence of > 10 5
bacteria / ml with the presence of withe cells in the urine, in
previously clear urine.
Deep infection: the presence of an intra-abdominal collection
confirmed clinically or radiologically.
Septicaemia : positive blood culture.
Pyrexia of unknown origin : any temperature above 37° C
for more than 24 h occuring after the original pyrexia following
surgery (if present) had settled , for which no obvious cause could
be found.
Wound dehiscence : superficial or deep wound breakdown.
Deep venous thrombosis and pulmonary embolus : when suspected,
confirmed radiologically by venography or ventilation/ perfusion
scanning or diagnosed at post mortem.
Cardiac failure : symptoms or signs of left ventricular or
congestive cardiac failure ( alteration from preoperative
measures)
Impaired renal function : arbitrarily defined as an increase
in blood urea of > 5 mmol / l from preoperative levels .
Hypotension : a fall in systolic blood pressure below 90 mmHg
for more than 2 H as determined by sphygmomanometry or arterial
pressure transducer measurement
Respiratory failure : respiratory difficulty requiring
emergency ventilation.
Anastomotic leak : discharge of bowel content via the drain,
wound or abnormal orifice.
Moderate surgery : cholecystectomy,
appendicectomy, mastectomy, transurethral resection of prostate
Major surgery : any laparotomy , bowel resection,
cholecystectomy with choledochotomy, peripheral vascular procedure or
major amputation
Major surgery + : any aortic procedure, abdominoperineal
resection, pancreatic or liver resection,
oesophagogastrectomy.