手术评估（SPA）评分可预测心脏手术后重症监护病房的住院时间。

The Surgical Procedure Assessment (SPA) score predicts intensive care unit length of stay after cardiac surgery.

机构信息

Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY 10032-3784, USA.

出版信息

J Thorac Cardiovasc Surg. 2011 Aug;142(2):443-50. doi: 10.1016/j.jtcvs.2010.09.067. Epub 2011 Apr 15.

DOI:10.1016/j.jtcvs.2010.09.067

PMID:21496830

Abstract

OBJECTIVE

The ability to predict intensive care unit length of stay greatly facilitates triage and resource allocation for postoperative cardiac surgical patients in the intensive care unit. We developed a simple, intuitive Surgical Procedure Assessment score that integrates surgical complexity (1, low; 2, intermediate; 3, high) with patient comorbidity (A, minimal; B, substantial). We hypothesized that the Surgical Procedure Assessment score would predict intensive care unit length of stay, discriminate preoperatively between fast-track and prolonged-stay patients, and compare favorably with more complex risk scores.

METHODS

After institutional review board approval, 1201 cardiac surgical patients were preoperatively assigned a Surgical Procedure Assessment score, as well as a Parsonnet, Tuman, Tu, and Cardiac Anesthesia Risk Evaluation score. We compared these scores with regard to prediction of intensive care unit length of stay, as well as their concordance in predicting intensive care unit length of stay of less than 48 hours (fast track) and more than 7 days (prolonged stay).

RESULTS

Intensive care unit length of stay increased significantly with increasing Surgical Procedure Assessment scores (P < .01, Cuzick's test for trend). The lowest Surgical Procedure Assessment score (1A) predicted intensive care unit length of stay of less than 48 hours, and the higher Surgical Procedure Assessment scores (2B or 3) predicted intensive care unit length of stay of more than 7 days more accurately than the Parsonnet, Tuman, Tu and Cardiac Anesthesia Risk Evaluation scores.

CONCLUSIONS

The Surgical Procedure Assessment score predicts intensive care unit length of stay better than other comparable scores. It is simple, intuitive, and easily understood by all caregivers and can preoperatively discriminate fast-track from prolonged-stay patients. It is a useful tool to facilitate intensive care unit triage.

摘要

目的

预测重症监护病房（ICU）的住院时间，极大地有助于对 ICU 术后心脏外科患者进行分诊和资源分配。我们开发了一种简单直观的手术程序评估评分，该评分将手术复杂性（1，低；2，中等；3，高）与患者合并症（A，最小；B，大量）相结合。我们假设手术程序评估评分可以预测 ICU 的住院时间，在术前区分快速通道和延长停留患者，并与更复杂的风险评分相比具有优势。

方法

在获得机构审查委员会批准后，对 1201 例心脏外科患者进行了术前手术程序评估评分，以及 Parsonnet、Tuman、Tu 和心脏麻醉风险评估评分。我们比较了这些评分在预测 ICU 住院时间方面的差异，以及它们在预测 ICU 住院时间少于 48 小时（快速通道）和超过 7 天（延长停留）方面的一致性。

结果

随着手术程序评估评分的增加，ICU 住院时间显著增加（P <.01，Cuzick 趋势检验）。最低的手术程序评估评分（1A）预测 ICU 住院时间少于 48 小时，而较高的手术程序评估评分（2B 或 3）比 Parsonnet、Tuman、Tu 和心脏麻醉风险评估评分更准确地预测 ICU 住院时间超过 7 天。