Bauhofer Artur, Lorenz Wilfried, Koller Michael, Menke Henrik, Sessler Daniel I, Sitter Helmut, Celik Ilhan, Nies Christoph, Wulf Hinnerk, Torossian Alexander
Institute of Theoretical Surgery, Philipps-University Marburg, Baldingerstrasse, 35043, Marburg, Germany.
Langenbecks Arch Surg. 2006 Aug;391(4):418-27. doi: 10.1007/s00423-005-0020-6. Epub 2006 Feb 7.
Postoperative outcome of patients is determined by recovery characteristics and self-reported quality of life. The first can be assessed with the McPeek score which values three aspects of recovery: mortality, postoperative critical care and duration of hospitalization.
We calculated the McPeek score of 669 patients in three trials: (1) colorectal cancer surgery, (2) antihistamine/volume loading in various operations, and (3) cholecystectomy. Beforehand, the average of intensive care unit treatment and duration of hospitalization were determined for the different operations to define McPeek score points. The score was tested on reliability, validity, and sensitivity. In addition, clinical applicability was assessed in a survey.
The score was reliable with similarly distributed score points in the three trials at different institutions. Inter-rater reliability was high (97% overlap). Validity was proven by moderate high correlation to convergent criteria such as complications (trial I to III r=0.43, r=0.38, r=0.60), preoperative American Society of Anesthesiologists class (ASA) (r=0.24, r=0.28, r=0.57), and age (r=0.23, r=0.32, r=0.31). The score was different between patients with and without neoplasms (P<0.001, trial II) and between elective or emergency patients (P<0.001, trial III). In a survey, investigators reported that the score was easy to assess and more comprehensive than four other scores.
The McPeek score values the postoperative outcome on a nonlinear scale. A priori, the average duration of hospitalization and critical care for a specific operation has to be defined. Our validation suggests that it is a reliable, valid, sensitive, and practical instrument for outcome analysis after anesthesia and surgery.
患者的术后结果由恢复特征和自我报告的生活质量决定。前者可通过麦克皮克评分进行评估，该评分对恢复的三个方面进行赋值：死亡率、术后重症监护和住院时长。
我们在三项试验中计算了669例患者的麦克皮克评分：（1）结直肠癌手术，（2）各类手术中使用抗组胺药/容量负荷，（3）胆囊切除术。事先确定了不同手术的重症监护病房治疗平均时长和住院时长，以确定麦克皮克评分点。对该评分进行了可靠性、有效性和敏感性测试。此外，通过一项调查评估了其临床适用性。
该评分具有可靠性，在不同机构的三项试验中评分点分布相似。评分者间信度较高（重叠率97%）。有效性通过与诸如并发症（试验I至III，r = 0.43、r = 0.38、r = 0.60）、术前美国麻醉医师协会分级（ASA）（r = 0.24、r = 0.28、r = 0.57）和年龄（r = 0.23、r = 0.32、r = 0.31）等趋同标准的中度高度相关性得到证实。有肿瘤和无肿瘤患者之间的评分存在差异（P < 0.001，试验II），择期或急诊患者之间的评分也存在差异（P < 0.001，试验III）。在一项调查中，研究者报告称该评分易于评估，且比其他四项评分更全面。
麦克皮克评分以非线性尺度评估术后结果。必须事先确定特定手术的住院和重症监护平均时长。我们的验证表明，它是麻醉和手术后结果分析的一种可靠、有效、敏感且实用的工具。
