de Castro S M M, Houwert J T, Lagarde S M, Reitsma J B, Busch O R C, van Gulik T M, Obertop H, Gouma D J
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
World J Surg. 2009 Jul;33(7):1481-7. doi: 10.1007/s00268-009-0037-z.
Comparison of operative morbidity rates after pancreatoduodenectomy between units may be misleading because it does not take into account the physiological variable of the condition of the patients. The aim of the present study was to evaluate the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) for pancreatoduodenectomy patients and to look for risk factors associated with morbidity in a high-volume center.
Between January 1993 and April 2006, 652 patients underwent a pancreatoduodenectomy, 502 of them for malignant disease. POSSUM performance was evaluated by assessing the "goodness-of-fit" with the linear analysis method.
Overall, 332 of the 652 patients (50.9%) had one or more complication after pancreatoduodenectomy, and 9 patients (1.4%) died. POSSUM had a significant lack of fit using goodness-of-fit analysis. In multivariate analysis, one statistically significant factor associated with morbidity and not incorporated in POSSUM (P < 0.05) was identified: ampulla of Vater adenocarcinoma (OR = 1.73, 95% CI: 1.07-2.80).
Overall, there is a lack of calibration of POSSUM among patients who undergo pancreatoduodenectomy.
不同医疗单位之间比较胰十二指肠切除术后的手术发病率可能会产生误导，因为这没有考虑到患者病情的生理变量。本研究的目的是评估胰十二指肠切除术患者的生理和手术严重程度评分系统（POSSUM），并在一个高手术量中心寻找与发病相关的危险因素。
1993年1月至2006年4月期间，652例患者接受了胰十二指肠切除术，其中502例为恶性疾病。通过线性分析方法评估POSSUM的“拟合优度”来评价其性能。
总体而言，652例患者中有332例（50.9%）在胰十二指肠切除术后发生了一种或多种并发症，9例（1.4%）死亡。通过拟合优度分析发现POSSUM存在明显的拟合不足。在多变量分析中，确定了一个与发病率相关且未纳入POSSUM的具有统计学意义的因素（P < 0.05）： Vater壶腹腺癌（OR = 1.73，95% CI：1.07 - 2.80）。
总体而言，接受胰十二指肠切除术的患者中POSSUM缺乏校准。
