# Preoperative mortality predictor (PMP) PMP Status: LIVE Price: $0.005 USDC `GET /api/calc/pmp` HTML: https://magentlab.com/docs/pmp Markdown: https://magentlab.com/docs/pmp.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the Ghanem 2012 Table 5 bedside preoperative mortality predictor and return the −1 to 30 total plus the printed Figure 3 0–5 and 20–30 interval facts. ## When to use When an agent needs the published Table 5 PMP point total and must not invent a go/no-go for surgery, race points, or the Table 4 open-pancreas odds ratio. ## When not to use - Not a medical device. Not a go/no-go for surgery, cancellation, or operative clearance. - magent does not assign functional status. poor_functional_status is the caller-assigned NSQIP totally-dependent flag (total assistance for all daily activities). - Table 5 bedside scoresheet only. No Table 4 open-pancreas odds ratio, no race parameter, no laboratory values, and no ASA class. - Age 65–69 is 0.5 as printed on Table 5, not the Discussion 1 / 1.5 / 2.5 wording. - Figure 3 reports <1% died in 0–5 and 73% died in 20–30. magent does not invent other risk labels. Those percents are cohort interval facts, not an individual probability. ## Formula ``` PMP = inpatient 6 + sepsis 4 + poor_functional_status 3 + disseminated_cancer 1 + age (>=80 -> 2; 70-79 -> 1; 65-69 -> 0.5; <65 -> 0) + cardiac_comorbidity 5 + pulmonary_comorbidity 3 + renal_comorbidity 1 + liver_comorbidity 1 + steroid_chronic 1 + weight_loss_gt_10_percent 1 + bleeding_disorder 1 + dnr 1 + obesity -1; Ghanem 2012 Table 5 bedside scoresheet; published range -1 through 30; Figure 3 <1% died in 0-5 and 73% died in 20-30; pmp_ge_20 is the 20-30 interval isolate ``` ## Citation [Predicting Risk of Death in General Surgery Patients on the Basis of Preoperative Variables Using American College of Surgeons National Surgical Quality Improvement Program Data](https://doi.org/10.7812/TPP/12-019) Vaid S, Bell T, Grim R, Ahuja V Perm J. 2012;16(4):10-16 DOI: [10.7812/TPP/12-019](https://doi.org/10.7812/TPP/12-019) ## Worked example ### Age 50, obesity only (score −1) Given: `age=50, bleeding_disorder=false, cardiac_comorbidity=false, disseminated_cancer=false, dnr=false, inpatient=false, liver_comorbidity=false, obesity=true, poor_functional_status=false, pulmonary_comorbidity=false, renal_comorbidity=false, sepsis=false, steroid_chronic=false, weight_loss_gt_10_percent=false` 1. Age 50 (<65) → 0; obesity → −1; all other Table 5 flags false 2. Score = −1; pmp_ge_20 false. Not a go/no-go for surgery. ### Inpatient, sepsis, age 82 (score 12) Given: `age=82, bleeding_disorder=false, cardiac_comorbidity=false, disseminated_cancer=false, dnr=false, inpatient=true, liver_comorbidity=false, obesity=false, poor_functional_status=false, pulmonary_comorbidity=false, renal_comorbidity=false, sepsis=true, steroid_chronic=false, weight_loss_gt_10_percent=false` 1. Inpatient → 6; sepsis → 4; age ≥80 → 2 2. Score = 6+4+2 = 12; pmp_ge_20 false. Not a go/no-go for surgery. ## Also searched as - preoperative mortality predictor - PMP score - bedside surgical mortality - NSQIP preoperative mortality - Vaid PMP - Ghanem 2012 PMP ## Parameters - `age` (integer, required): Age in years (18-120). Ghanem 2012 Table 5: ≥80 → 2; 70–79 → 1; 65–69 → 0.5; <65 → 0. Age 65 and 69 score 0.5; 70 and 79 score 1; 80 scores 2. Table 5 only (not the Discussion 1 / 1.5 / 2.5 wording). - `inpatient` (boolean, required): Inpatient status (Ghanem 2012 Table 5). true scores 6. Caller-assigned; magent does not classify admission status. - `sepsis` (boolean, required): Preoperative sepsis as assigned by the caller (Ghanem 2012 Table 5). true scores 4. magent does not diagnose sepsis. - `poor_functional_status` (boolean, required): Poor functional status: total assistance required for all daily activities (Ghanem 2012 Table 5 / NSQIP totally dependent). true scores 3. magent does not assign functional status. - `disseminated_cancer` (boolean, required): Disseminated cancer as assigned by the caller (Ghanem 2012 Table 5). true scores 1. magent does not diagnose cancer. - `cardiac_comorbidity` (boolean, required): Cardiac comorbidity as assigned by the caller (Ghanem 2012: dyspnea, heart failure, myocardial infarction, angina, peripheral artery disease, or hypertension requiring medication). true scores 5. magent does not diagnose cardiac disease. - `pulmonary_comorbidity` (boolean, required): Pulmonary comorbidity as assigned by the caller (Ghanem 2012: ventilator, COPD, or current pneumonia). true scores 3. magent does not diagnose lung disease. - `renal_comorbidity` (boolean, required): Renal comorbidity as assigned by the caller (Ghanem 2012: dialysis or renal failure). true scores 1. magent does not grade kidney disease. - `liver_comorbidity` (boolean, required): Liver comorbidity as assigned by the caller (Ghanem 2012: ascites or esophageal varices). true scores 1. magent does not grade liver disease. - `steroid_chronic` (boolean, required): Steroid for a chronic condition (Ghanem 2012 Table 5). true scores 1. magent does not read a medication list. - `weight_loss_gt_10_percent` (boolean, required): Loss of >10% body weight in the last 6 months (Ghanem 2012 Table 5). true scores 1. magent does not compute weight change. - `bleeding_disorder` (boolean, required): Bleeding disorder as assigned by the caller (Ghanem 2012 Table 5). true scores 1. magent does not diagnose coagulopathy. - `dnr` (boolean, required): Do-not-resuscitate directive (Ghanem 2012 Table 5). true scores 1. magent does not read code-status orders. - `obesity` (boolean, required): Obesity as assigned by the caller (Ghanem 2012 Table 5). true scores −1. magent does not compute BMI. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/pmp` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "age": "50", "bleeding_disorder": "false", "cardiac_comorbidity": "false", "disseminated_cancer": "false", "dnr": "false", "inpatient": "false", "liver_comorbidity": "false", "obesity": "true", "poor_functional_status": "false", "pulmonary_comorbidity": "false", "renal_comorbidity": "false", "sepsis": "false", "steroid_chronic": "false", "weight_loss_gt_10_percent": "false" }, { "age": "50", "bleeding_disorder": "false", "cardiac_comorbidity": "false", "disseminated_cancer": "false", "dnr": "false", "inpatient": "false", "liver_comorbidity": "false", "obesity": "true", "poor_functional_status": "false", "pulmonary_comorbidity": "false", "renal_comorbidity": "false", "sepsis": "false", "steroid_chronic": "false", "weight_loss_gt_10_percent": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/pmp Example 200: ```json { "count": 2, "path": "/api/calc/pmp", "items": [ { "components": [ { "factor": "inpatient", "points": 0, "present": false }, { "factor": "sepsis", "points": 0, "present": false }, { "factor": "poor_functional_status", "points": 0, "present": false }, { "factor": "disseminated_cancer", "points": 0, "present": false }, { "value": 50, "factor": "age", "points": 0, "present": false }, { "factor": "cardiac_comorbidity", "points": 0, "present": false }, { "factor": "pulmonary_comorbidity", "points": 0, "present": false }, { "factor": "renal_comorbidity", "points": 0, "present": false }, { "factor": "liver_comorbidity", "points": 0, "present": false }, { "factor": "steroid_chronic", "points": 0, "present": false }, { "factor": "weight_loss_gt_10_percent", "points": 0, "present": false }, { "factor": "bleeding_disorder", "points": 0, "present": false }, { "factor": "dnr", "points": 0, "present": false }, { "factor": "obesity", "points": -1, "present": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "age_years": 50, "citation": { "authors": "Vaid S, Bell T, Grim R, Ahuja V", "doi": "10.7812/TPP/12-019", "id": "ghanem-2012", "pmid": "23251111", "source": "Perm J. 2012;16(4):10-16", "title": "Predicting Risk of Death in General Surgery Patients on the Basis of Preoperative Variables Using American College of Surgeons National Surgical Quality Improvement Program Data" }, "formula": "pmp", "formula_expression": "PMP = inpatient 6 + sepsis 4 + poor_functional_status 3 + disseminated_cancer 1 + age (>=80 -> 2; 70-79 -> 1; 65-69 -> 0.5; <65 -> 0) + cardiac_comorbidity 5 + pulmonary_comorbidity 3 + renal_comorbidity 1 + liver_comorbidity 1 + steroid_chronic 1 + weight_loss_gt_10_percent 1 + bleeding_disorder 1 + dnr 1 + obesity -1; Ghanem 2012 Table 5 bedside scoresheet; published range -1 through 30; Figure 3 <1% died in 0-5 and 73% died in 20-30; pmp_ge_20 is the 20-30 interval isolate", "max_score": 30, "score": -1, "figure3_died_percent": null, "pmp_ge_20": false, "score_interval": null }, { "components": [ { "factor": "inpatient", "points": 0, "present": false }, { "factor": "sepsis", "points": 0, "present": false }, { "factor": "poor_functional_status", "points": 0, "present": false }, { "factor": "disseminated_cancer", "points": 0, "present": false }, { "value": 50, "factor": "age", "points": 0, "present": false }, { "factor": "cardiac_comorbidity", "points": 0, "present": false }, { "factor": "pulmonary_comorbidity", "points": 0, "present": false }, { "factor": "renal_comorbidity", "points": 0, "present": false }, { "factor": "liver_comorbidity", "points": 0, "present": false }, { "factor": "steroid_chronic", "points": 0, "present": false }, { "factor": "weight_loss_gt_10_percent", "points": 0, "present": false }, { "factor": "bleeding_disorder", "points": 0, "present": false }, { "factor": "dnr", "points": 0, "present": false }, { "factor": "obesity", "points": -1, "present": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "age_years": 50, "citation": { "authors": "Vaid S, Bell T, Grim R, Ahuja V", "doi": "10.7812/TPP/12-019", "id": "ghanem-2012", "pmid": "23251111", "source": "Perm J. 2012;16(4):10-16", "title": "Predicting Risk of Death in General Surgery Patients on the Basis of Preoperative Variables Using American College of Surgeons National Surgical Quality Improvement Program Data" }, "formula": "pmp", "formula_expression": "PMP = inpatient 6 + sepsis 4 + poor_functional_status 3 + disseminated_cancer 1 + age (>=80 -> 2; 70-79 -> 1; 65-69 -> 0.5; <65 -> 0) + cardiac_comorbidity 5 + pulmonary_comorbidity 3 + renal_comorbidity 1 + liver_comorbidity 1 + steroid_chronic 1 + weight_loss_gt_10_percent 1 + bleeding_disorder 1 + dnr 1 + obesity -1; Ghanem 2012 Table 5 bedside scoresheet; published range -1 through 30; Figure 3 <1% died in 0-5 and 73% died in 20-30; pmp_ge_20 is the 20-30 interval isolate", "max_score": 30, "score": -1, "figure3_died_percent": null, "pmp_ge_20": false, "score_interval": null } ] } ``` ## Response fields - `formula` (string): pmp - `formula_expression` (string): Exact Ghanem 2012 Table 5 bedside expression - `score` (number): Table 5 PMP points; published range −1 through 30. Age 65–69 contributes 0.5. - `max_score` (integer): 30 (Table 5 highest possible score) - `age_years` (integer): Age in years used for the age band - `pmp_ge_20` (boolean): true when score ≥ 20, isolating the Figure 3 20–30 interval (73% died in that cohort group). Not a go/no-go for surgery. - `score_interval` (string): Figure 3 printed intervals only: 0-5 or 20-30. Null when the total is outside those ranges. magent does not invent other labels. - `figure3_died_percent` (string): Published Figure 3 cohort facts: <1% in 0–5, 73% in 20–30. Null outside those intervals. A group percent, not an individual probability. - `components` (array): Per-factor points - `citation` (object): Ghanem 2012 Permanente Journal citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "factor": "inpatient", "points": 0, "present": false }, { "factor": "sepsis", "points": 0, "present": false }, { "factor": "poor_functional_status", "points": 0, "present": false }, { "factor": "disseminated_cancer", "points": 0, "present": false }, { "value": 50, "factor": "age", "points": 0, "present": false }, { "factor": "cardiac_comorbidity", "points": 0, "present": false }, { "factor": "pulmonary_comorbidity", "points": 0, "present": false }, { "factor": "renal_comorbidity", "points": 0, "present": false }, { "factor": "liver_comorbidity", "points": 0, "present": false }, { "factor": "steroid_chronic", "points": 0, "present": false }, { "factor": "weight_loss_gt_10_percent", "points": 0, "present": false }, { "factor": "bleeding_disorder", "points": 0, "present": false }, { "factor": "dnr", "points": 0, "present": false }, { "factor": "obesity", "points": -1, "present": true } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "age_years": 50, "citation": { "authors": "Vaid S, Bell T, Grim R, Ahuja V", "doi": "10.7812/TPP/12-019", "id": "ghanem-2012", "pmid": "23251111", "source": "Perm J. 2012;16(4):10-16", "title": "Predicting Risk of Death in General Surgery Patients on the Basis of Preoperative Variables Using American College of Surgeons National Surgical Quality Improvement Program Data" }, "formula": "pmp", "formula_expression": "PMP = inpatient 6 + sepsis 4 + poor_functional_status 3 + disseminated_cancer 1 + age (>=80 -> 2; 70-79 -> 1; 65-69 -> 0.5; <65 -> 0) + cardiac_comorbidity 5 + pulmonary_comorbidity 3 + renal_comorbidity 1 + liver_comorbidity 1 + steroid_chronic 1 + weight_loss_gt_10_percent 1 + bleeding_disorder 1 + dnr 1 + obesity -1; Ghanem 2012 Table 5 bedside scoresheet; published range -1 through 30; Figure 3 <1% died in 0-5 and 73% died in 20-30; pmp_ge_20 is the 20-30 interval isolate", "max_score": 30, "score": -1, "figure3_died_percent": null, "pmp_ge_20": false, "score_interval": null } ``` ## Errors - HTTP 400 `invalid_pmp`: PMP needs Ghanem 2012 bedside preoperative flags and age band in published ranges. Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [POSSUM](https://magentlab.com/docs/possum) — Sum Copeland 1991 Table 1 physiologic and Table 2 operative severity items, then return the published morbidity and mortality probabilities from the unrounded logits. - [Gupta PRF](https://magentlab.com/docs/gupta-prf) — Compute the Gupta 2011 Chest logistic probability of postoperative respiratory failure (mechanical ventilation >48 h after surgery or unplanned intubation within 30 days) from ASA class, functional status, preoperative sepsis, emergency case, and surgery type. - [RCRI](https://magentlab.com/docs/rcri) — Sum the six Lee 1999 revised cardiac risk index factors and return class I–IV. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.