Department of Vascular Surgery, St Vincent’s Hospital, Dublin, Ireland.
Ir J Med Sci. 2009 Dec;178(4):453-6. doi: 10.1007/s11845-009-0280-1.
Currently, crude morbidity and mortality rates are used to assess vascular surgical outcome. However, as a high-risk specialty, this may not be representative of quality of care.
We evaluated the POSSUM score as a measure of performance in our vascular unit, and also its usefulness on an individual patient basis for predicting outcome.
A total of 106 patients were prospectively scored using the vascular-POSSUM score, and mean predicted and observed morbidity and mortality were compared with one-sample t tests.
Receiver operator characteristic curves were used to determine if POSSUM scores were associated with the end-points of morbidity and mortality. Predicted and observed morbidity (41 and 35.8%, respectively) were not significantly different (P = 0.066). POSSUM did, however, over-predict mortality at 9.7% compared to the observed mortality of 5.7% (P = 0.021). While the discrimination for predicting morbidity was poor, POSSUM scores were significantly associated with mortality endpoints (area under ROC curve = 0.97250). POSSUM morbidity scores closely correlate with observed outcomes.
Although POSSUM did over-predict mortality, high mortality scores may be useful for identifying patients at particularly high risk post-operatively. The POSSUM score is a useful adjunct to interpretation of morbidity and mortality statistics, and we would recommend its wider implementation for surgical audit.
目前，使用粗死亡率和发病率来评估血管外科学术成果。然而，作为一个高风险的专业，这可能无法代表护理质量。
我们评估 POSSUM 评分作为评估我们血管单位绩效的一种方法，以及其在预测个体患者预后方面的有用性。
共有 106 例患者前瞻性地使用血管-POSSUM 评分进行评分，并通过单样本 t 检验比较平均预测发病率和死亡率与观察发病率和死亡率。
使用接收者操作特征曲线来确定 POSSUM 评分是否与发病率和死亡率的终点相关。预测发病率和观察发病率（分别为 41%和 35.8%）没有显著差异（P=0.066）。然而， POSSUM 确实高估了死亡率，为 9.7%，而观察到的死亡率为 5.7%（P=0.021）。虽然预测发病率的区分度较差，但 POSSUM 评分与死亡率终点显著相关（ROC 曲线下面积=0.97250）。 POSSUM 发病率评分与观察到的结果密切相关。
尽管 POSSUM 高估了死亡率，但高死亡率评分可能有助于识别术后风险特别高的患者。 POSSUM 评分是解释发病率和死亡率统计数据的有用辅助工具，我们建议更广泛地将其用于手术审查。
