The Predictive Value Of Modified Possum Scoring System In The Incidence Of Complications Of Pulmonary Surgery Under Scope Assisted Thoracic Surgery

Objective There is no clear standard in evaluation patient’s tolerance towards lung surgery by far,and to determine the incidence of postoperative complications.Doctors rely mostly on clinical experience to make clinical judgment,which tend to be reckless compared with data based mathematical analysis.This study was designed to investigate a modified POSSUM scoring system for improving method,which can be used in thoracoscopic lung surgery complication rate forecast,provide quantitative basis for the clinical decision making,which also can be the basis on improving the physiological state of patients before operation.Method The original POSSUM score was modified,by means of excluding indicators which are not suitable for thoracic surgery,using logistic regression to adjust factors in original POSSUM system(the scope of operation and malignant tumor)and incorporating new factors(FEV1%,APTT,LVEF%,operation time surgery).Thus a modified POSSUM system is established and mathematical model is used to predict the incidence of postsurgical complications.176 cases underwent pulmonary thoracoscopic surgery were collected,under whose corresponding index we achieved modified POSSUM scoring system.We further reckoned prediction of the incidence of postoperative complications using modified POSSUM scoring system,and compared with actual postoperative complication rate to evaluate accuracy and sensitivity of prediction equation newly modified.Results There were 38 of the 176 patients had postoperative complications.Logistic regression analysis showed that APTT(0.133,0.038),FEV1%(0.030,0.029),left ventricular ejection fraction(LVEF)(-0.288,0.029),operation time(0.571,0.012),the extent of surgery(-0.833,0.007)were independent factors of surgery complications.The modified POSSUM scoring equation(In R/1-R =-6.299+(physiological 0.102* scores)+(0.278* operative severity score),(R is the predicted postoperative complication incidence)have good predictive value(see Table 6 and table 7).Conclusion The modified POSSUM system had a good predictive value for the incidence of complications in the thoracic surgery.When the predicted complication rate was greater than 13.5%,the complication rate of the patient appeared higher,a more throughout preoperative preparation and more appropriate preoperative conversation should be considered.