Apply POSSUM Scoring System To Estimate Thoracic Surgery Patients Whether Need To Be Transferred To ICU Directly After Operation

Objective: The range of thoracic surgery mainly includes lung, esopha-gus, cardia of stomach, and mediastinal tumor resection, the operation willmake a more serious harassment to the two most important organs of thehuman body in the thoracic cavity which are heart and lung. Therefore in thewhole surgical area, the thoracic surgery is very complicated and difficulty, thepostoperative complications are also more ominous. So if patients do not havea good physiological condition before operation, it will be bound to increasethe postoperative risk. But tumor surgery belongs to deadline surgery, it willnot have sufficient time to adjust the patient’s physiological condition beforeoperation. And we have observed in practical work, if patients with poorpreoperative physiological conditions are directly transferred to ICU afteroperation, and provide them intervention and support early, that they will havea lower mortality. Now Critical Care Medicine (ICU) Division already has aconsiderable advancement and development, it indeed has reduced themortality of critically ill patients of medicine and surgery in a greater extent.So patients who does not have surgical contraindication, but have poorphysiological conditions before operation, can be directly transferred to IUCafter operation. However, ICU resources are relatively scarce, treatment costsare also much higher than the general ward, and moreover not all patients withpoor preoperative physiological conditions need to be transferred to ICUdirectly after operation. For so many surgical patients, which patients need tobe transferred to ICU directly after operation, at this stage only rely on thedoctor’s experience. Therefore, need to find a relatively objective way toevaluate the patients and enable doctor to be able to make better judgments, atlast achieve the therapeutic effect and the interests of a win-win situation, but at the current related researches are less.In the medical field now, only APACHE II/III scoring system andPOSSUM scoring system can have a comprehensive assessment for patients,and show a good predictive ability, as well as have been widely used. Butaccording to the results of study now, APACHE II/III scoring system now isstill most suitable for use in ICU. However, because POSSUM scoring systemincludes the assessment of the physiological status and surgical severity, it ismore suitable for surgical patients. It is not only able to predict mortality, andalso originally can predict morbidity in patients．So in this study, selectPOSSUM scoring system as the research object and observation.Methods: A retrospective analysis from Jan.2010to Dec.2011，it wasabout133patients who ever had undergone the thoracic surgery at the FourthHospital of Hebei Medical University, and been transferred to ICU afteroperation. Captured and organized information and data of the133patients,calculated each patient’s physiology score, operative severity score, the time ofendotracheal intubation ventilator-assisted breathing at ICU and ICU length ofstay. Through the regression equations of POSSUM scoring system, calculatedthe morbidity (R1) and mortality (R2) for each case. First, we compared thedifference between the mortality calculated by POSSUM system and theactual mortality. Then divided133patients into two groups, one group were43patients who were transferred directly to ICU after operation in order to gothrough perioperation period safely, and referred to be transferred directly toICU group after operation, the other group were90patients who weretransferred to ICU when they had serious complications after operation, andreferred to not be transferred directly to ICU group after operation, meanwhilecounted the number of actual death. Taken morbidity R1as the analysisindicator and death as the gold standard, drawn a ROC curve to find out thecut-off point of morbidity R1of the group which patiens did not be transferreddirectly to ICU after operation. And we compared the time of endotrachealintubation ventilator-assisted breathing at ICU and ICU length of stay betweenthe two groups. Statistical methods: All data applied the IBM SPSS Statistics19processing, and analysis of the measurement data was used T-testand nonparametric rank sum test, count data was used chi-square test, P <0.05was considered as statistical significant.Results: There were27actual death cases in133patients. When removed6patients who died30days later after operation, POSSUM score systempredicted that there were23patients dead，actually21patients dead, there wasnot a statistical difference between them (χ~2=0.110, df=1, P=0.74, P＞0.05).In the group which90patients patiens did not be transferred directly to ICUafter operation, through the ROC curve fond that the sum of the sensitivity andspecificity was maximumest when morbidity R1was60.5%. For further test，after counting, in this group，there were41patients whose R1was less than60.5%, and6patients dead; There were49patients whose R1was not lessthan60.5%, and17patients dead; There was a statistical difference betweenthe actual mortality of two sets (χ~2=4.721, df=1, P=0.03, P<0.05). In the othergroup which patients were transferred directly to ICU after operation，therewere19patients whose R1was less than60.5%, and2patients dead; Therewere24patients whose R1was not less than60.5%, and2patients dead;There was not a statistical difference between the actual mortality of two sets(χ~2=0.06df=1, P=0.903, Fisher exact test two-sided test P=1.0, P>0.05).Compared the actual mortality of the two groups patients whose R1was lessthan60.5%, there was not a statistical difference between them, χ~2=0.19, df=1, P=0.663, Fisher exact test two-sided test P=1.0, P>0.05. Compared theactual mortality of the two groups patients whose R1was not less than60.5%,there was a statistical difference between them, χ~2=5.814, df=1, P=0.016,P<0.05. In the group which patients did not be transferred directly to ICU afteroperation, the average time of endotracheal intubation ventilator-assistedbreathing was6.27±4.69days, the average ICU length of stay was8.61±5.33days. In the other group which patients were transferred directly to ICUafter operation, the average time of endotracheal intubation ventilator-assistedbreathing was3.74±2.52days, the average ICU length of stay was5.81±3.13days. Through the nonparametric rank sum tested, there were statistical differences in the time of endotracheal intubation ventilator-assisted breathing andICU length of stay between two groups, the P values were both less than0.05.Conclusion:1.POSSUM scoring system can be used to estimate whetherthe thoracic surgery patients need to be transferred to ICU directly afteroperation.2.If the morbidity R1calculated by POSSUM score system is notless than60.5%, the patient should be transferred to ICU directly afteroperation. so that the patient’s condition can stabilize as soon as possible andlet the mortality decrease.3.The patient whose morbidity R1is not less than60.5%calculated by POSSUM score system, is transferred to ICU directly afteroperation, the mortality will be reduced.4. If the thoracic surgery patients aretransferred to ICU directly after operation, the time of endotracheal intubationventilator-assisted breathing and ICU length of stay relatively will be reduced.