anaesthesia-icu

POSSUM Score for Surgical Morbidity and Mortality

Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM). Uses 12 physiological and 6 operative variables to predict 30-day morbidity and mortality. P-POSSUM is modified for mortality prediction.

Age (years)*

Cardiac signs*

Respiratory signs*

Systolic blood pressure (mmHg)*

Pulse rate (bpm)*

Glasgow Coma Score*

Haemoglobin (g/dL)*

WCC (×10³/mm³)*

Urea (mmol/L)*

Sodium (mmol/L)*

Potassium (mmol/L)*

ECG*

Operative severity*

Multiple procedures*

Total blood loss (mL)*

Peritoneal contamination*

Presence of malignancy*

Timing of operation*

Score interpretation

Low Risk 0–20

Low combined POSSUM score — low predicted morbidity/mortality

→ Proceed with planned surgery; standard perioperative care; consider HDU for post-op monitoring if any concerns

Moderate Risk 21–40

Moderate combined POSSUM score — intermediate risk

→ Surgical and anaesthetic risk discussion with patient; consent documentation; HDU bed planning; senior anaesthetist involvement; optimise reversible risk factors pre-op; CPEX testing if cardiac/respiratory concerns

High Risk 41–200

High combined POSSUM score — high predicted morbidity/mortality

→ Formal risk-benefit discussion with patient and family; document estimated mortality risk in consent; ICU bed planning; senior consultant involvement; joint surgical/anaesthetic/ICU decision; consider palliation if non-surgical management is viable alternative

Interpretation bands for the POSSUM. Apply clinical judgement and local guidance.

References

Copeland GP et al. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78(3):355–360.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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