title: Risk assessment and decision-making for patients undergoing orthopedic surgery.
abstract: OBJECTIVE
  Physical and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring system was designed to predict the postoperative morbidity and mortality mainly in general surgery. The purpose of this study was to assess the value of POSSUM scoring system in predicting outcomes of patients undergoing orthopedic surgery, and to do some modifications to make the system more accurate in predicting postoperative complication rates.
  
  
  METHODS
  This is a retrospective clinical study involving 779 patients between April 1, 2009 and September 1, 2010. The postoperative complication rates were predicted by POSSUM, and then compared with the actual morbidity. Logistic regression was taken to improve the POSSUM equation.
  
  
  RESULTS
  In the 779 cases, the predicted morbidity was 27.2% (212 cases) by POSSUM, while the actual morbidity is 8.3% (65 cases).
  
  
  CONCLUSIONS
  POSSUM excessively predicted the morbidity of patients undergoing orthopedic surgery, and it could be more accurate with appropriate modification. Of all risk factors, echocardiography ejection fraction showed a close relationship with postoperative complications.
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China. ssxzbdm@163.com.
authors.forename: De-ming
authors.initials: DM
authors.lastname: Bao
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China. lining117826@126.com.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450052, China. zxzmx@126.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Xia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D055815:Young Adult