Slim Karem, Panis Yves, Alves Arnaud, Kwiatkowski Fabrice, Mathieu Pierre, Mantion Georges
Department of Digestive Surgery, Hôtel-Dieu, Clermont-Ferrand, Boulevard Leon Malfreyt, Clermont-Ferrand Cedex 1, F-63058, France.
World J Surg. 2006 Jan;30(1):100-6. doi: 10.1007/s00268-005-0081-2.
Well-known and suitable instruments for surgical audit are the POSSUM and P-POSSUM scoring systems. But these scores have not been well validated across the countries. The objective of the present study was to assess the predictive value of scores for colorectal surgery in France. Patients operated on for colorectal malignant or diverticular diseases, whether electively or on emergency basis, within a 4-month period were included in a prospective multicenter study conducted by the French Association for Surgery (Association Française de Chirurgie, AFC). The main outcome measure was postoperative in-hospital mortality. Independent factors leading to death were assessed by multivariate logistic regression analysis (AFC-index). The ratio of expected versus observed deaths was calculated, and the predictive value of the POSSUM and P-POSSUM scores were analyzed by the receiver operating characteristic (ROC) curve. A total of 1426 patients were included. The in-hospital death rate was 3.4%. Four independent preoperative factors (AFC-index) have been found: emergency surgery, loss of more than 10% of weight, neurological disease history, and age > 70 years. POSSUM had a poor predictive value; it overestimated postoperative death in all cases. P-POSSUM had a good predictive value, except for elective surgery, where it overestimated postoperative death twofold. The predictive value of the AFC-index was also good. It had the same sensitivity and specificity as the P-POSSUM. POSSUM has not been validated in France in the field of colorectal surgery. P-POSSUM was as predictive as the AFC-index which is a simpler instrument based on four clinical parameters (without any mathematical formulas).
著名且适用的外科手术评估工具是POSSUM和P-POSSUM评分系统。但这些评分在各国尚未得到充分验证。本研究的目的是评估法国结直肠手术评分的预测价值。在4个月内接受结直肠恶性或憩室疾病手术的患者，无论择期还是急诊手术，均纳入法国外科学会（Association Française de Chirurgie, AFC）开展的一项前瞻性多中心研究。主要结局指标是术后住院死亡率。通过多因素逻辑回归分析（AFC指数）评估导致死亡的独立因素。计算预期死亡与观察死亡的比例，并通过受试者工作特征（ROC）曲线分析POSSUM和P-POSSUM评分的预测价值。共纳入1426例患者。住院死亡率为3.4%。发现了四个独立的术前因素（AFC指数）：急诊手术、体重减轻超过10%、有神经疾病史以及年龄>70岁。POSSUM的预测价值较差；在所有情况下均高估了术后死亡率。P-POSSUM的预测价值良好，但择期手术除外，在择期手术中它将术后死亡率高估了两倍。AFC指数的预测价值也良好。它与P-POSSUM具有相同的敏感性和特异性。POSSUM在法国结直肠手术领域尚未得到验证。P-POSSUM与AFC指数的预测能力相当，AFC指数是一种基于四个临床参数（无任何数学公式）的更简单工具。
