Bennett-Guerrero E, Hyam J A, Shaefi S, Prytherch D R, Sutton G L, Weaver P C, Mythen M G, Grocott M P, Parides M K
Department of Anesthesiology, Columbia University College of Physicians and Surgeons, Columbia University Mailman School of Public Health, New York, USA.
Br J Surg. 2003 Dec;90(12):1593-8. doi: 10.1002/bjs.4347.
The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) criteria have been used to assess surgical risk in patients in the UK. The aim was to determine how applicable these criteria are to patients undergoing surgery in the USA.
Two cohorts of patients undergoing major non-cardiac surgery were followed prospectively in the USA (n = 1056) and the UK (n = 1539). Each patient was assigned a risk score for preoperative physiological status and operative severity using the established POSSUM criteria. Death in hospital was the primary outcome measure. For each patient a predicted risk of death was calculated from Portsmouth POSSUM (P-POSSUM) methodology using an established equation. The relationships between predicted and observed mortality rates in each cohort were investigated by means of multivariate logistic regression.
Within each cohort, an increase in risk estimated by P-POSSUM predicted an increase in observed mortality rate (P < 0.001). For any given risk level, however, mortality rates were significantly higher in the UK cohort than in the US cohort (odds ratio 4.50 (95 per cent confidence interval 2.81 to 7.19); Z = 6.25, P < 0.001).
An increase in predicted risk, based on the P-POSSUM methodology, was associated with a higher mortality rate in patients from both countries. However, risk-adjusted mortality rates following major surgery were four times higher in the UK cohort. These marked differences warrant validation in a larger number of centres.
用于计算死亡率和发病率的生理与手术严重程度评分（POSSUM）标准已在英国用于评估患者的手术风险。目的是确定这些标准在美国接受手术的患者中的适用程度。
在美国（n = 1056）和英国（n = 1539）对两组接受非心脏大手术的患者进行前瞻性随访。使用既定的POSSUM标准为每位患者术前生理状态和手术严重程度指定一个风险评分。住院死亡是主要结局指标。对于每位患者，使用既定方程通过朴茨茅斯POSSUM（P-POSSUM）方法计算预测死亡风险。通过多变量逻辑回归研究每个队列中预测死亡率与观察到的死亡率之间的关系。
在每个队列中，P-POSSUM估计的风险增加预示着观察到的死亡率增加（P < 0.001）。然而，对于任何给定的风险水平，英国队列中的死亡率显著高于美国队列（优势比4.50（95%置信区间2.81至7.19）；Z = 6.25，P < 0.001）。
基于P-POSSUM方法，预测风险的增加与两国患者较高的死亡率相关。然而，英国队列中大手术后经风险调整的死亡率高出四倍。这些显著差异需要在更多中心进行验证。
