Role of Modified Early Warning Score in Early Detection of Post-Operative Morbidity and Mortality

Abstract

Background: Postoperative clinical deterioration remains a major contributor to preventable morbidity and mortality in surgical patients. Early identification of physiological instability is essential to enable timely intervention. The Modified Early Warning Score (MEWS) is a bedside scoring system based on routinely measured vital parameters designed to detect early deterioration. However, data evaluating its predictive role in general surgical patients in Indian tertiary care settings remain limited.

Aim: To assess the efficacy of MEWS score in predicting post-operative decline in general surgical patients.

Methods: This cross-section study was conducted over a two-year period (June 2023–May 2025) in the Department of General Surgery at NRI General Hospital, Chinnakakani, Guntur. A total of 100 adult patients undergoing major surgical procedures under general or regional anaesthesia were enrolled. Postoperative physiological parameters — including pulse rate, respiratory rate, systolic blood pressure, temperature, urine output, and level of consciousness (AVPU scale)—were recorded, and MEWS was calculated. The highest MEWS score documented prior to clinical stabilization or deterioration was analysed. Primary outcome was in-hospital mortality. Secondary outcomes included ICU admission and duration of hospital stay.

Results: Fifty-three patients (53%) required postoperative ICU admission, while 47 (47%) were managed in the ward. The mean MEWS score was significantly higher in ICU patients compared to ward patients (4.32 ± 1.50 vs. 1.97 ± 0.94; p < 0.001). Significant associations were observed between ICU admission and abnormal pulse rate (p < 0.001), respiratory rate (p < 0.001), temperature (p < 0.001), urine output (p = 0.0017), and altered level of consciousness (p < 0.001). Systolic blood pressure did not show significant association (p = 0.494). Overall mortality was 8%, with all deaths occurring in the ICU group (p = 0.017). The mean MEWS score among deceased patients was 6.37, significantly higher than among survivors.

Conclusion: Elevated MEWS scores were strongly associated with postoperative ICU admission and in-hospital mortality. MEWS serves as a simple, cost-effective, and reliable bedside tool for early detection of physiological deterioration in surgical patients. Routine implementation of MEWS in postoperative monitoring protocols may facilitate timely escalation of care, optimize ICU utilization, and potentially reduce preventable postoperative mortality.