评估O-POSSUM在预测食管癌切除术后院内死亡率中的作用。
Evaluation of O-POSSUM in predicting in-hospital mortality after resection for oesophageal cancer.
作者信息
Lagarde S M, Maris A K D, de Castro S M M, Busch O R C, Obertop H, van Lanschot J J B
机构信息
Department of Surgery, Academic Medical Centre at the University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
出版信息
Br J Surg. 2007 Dec;94(12):1521-6. doi: 10.1002/bjs.5850.
BACKGROUND
The aims of the present study were to validate the Physiological and Operative Severity Score for the enUmeration of Mortality adjusted for oesophagogastric surgery (O-POSSUM).
METHODS
Data on patients who underwent potentially curative oesophagectomy in a tertiary referral centre for adenocarcinoma or squamous cell carcinoma of the oesophagus were analysed. The in-hospital mortality predicted by O-POSSUM was compared with the actual value by linear analysis.
RESULTS
Twenty-four (3.6 per cent) of 663 patients died in hospital. The observed : predicted ratio for in-hospital mortality was 0.29. The model had a poor fit (P < 0.001). The area under the receiver-operator characteristic curve was 0.60 (95 per cent confidence interval 0.47 to 0.72); P = 0.113). O-POSSUM score was not related to the severity of complications.
CONCLUSION
O-POSSUM overpredicted in-hospital mortality threefold and could not identify patients at higher risk of death. O-POSSUM needs substantial modification before it can be used for comparison of treatment outcomes between centres.
背景
本研究的目的是验证用于食管胃手术死亡率调整计数的生理与手术严重程度评分（O-POSSUM）。
方法
分析了在一家三级转诊中心接受食管癌或食管鳞状细胞癌潜在根治性食管切除术患者的数据。通过线性分析比较了O-POSSUM预测的院内死亡率与实际值。
结果
663例患者中有24例（3.6%）在医院死亡。观察到的院内死亡率与预测死亡率之比为0.29。该模型拟合度较差（P<0.001）。受试者工作特征曲线下面积为0.60（95%置信区间0.47至0.72）；P=0.113）。O-POSSUM评分与并发症严重程度无关。
结论
O-POSSUM将院内死亡率高估了三倍，且无法识别死亡风险较高的患者。在可用于中心间治疗结果比较之前，O-POSSUM需要进行实质性修改。
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