Brigham and Women's Hospital, Department of Surgery, Center for Surgery and Public Health, Boston, MA, USA.
J Am Coll Surg. 2011 Aug;213(2):220-5. doi: 10.1016/j.jamcollsurg.2011.04.025. Epub 2011 May 31.
Whether preoperative risk prediction improves with the use of more patient- and procedure-targeted models is unclear. We created a customized preoperative mortality risk prediction score for patients 80 years or older needing an emergency colectomy and compare it with existing, more generic risk assessment methods.
A targeted mortality prediction model was created using 2007 to 2008 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data and was validated using 2005 to 2006 data. We constructed a scoring system from the significant predictors identified. The model fit of our targeted score was compared with the American Society of Anesthesiologist's (ASA) score, the Surgical Risk Scale, and the ACS Colorectal Surgery Risk Calculator.
Analyses identified 1,358 and 372 emergency colectomies in the training and validation samples, respectively. Our targeted risk prediction score had a goodness-of-fit p value greater than 0.05 (indicating a good fit) and a c-statistic of 0.77, which represents a significantly better fit compared with the ASA score, the Surgical Risk Scale, and the ACS Colorectal Surgery Risk Calculator c-statistics (0.66, 0.66, and 0.71, respectively). When using the scores to predict mortality with 80% specificity, our targeted risk prediction score was 25% more likely to predict correctly than the ACS Colorectal Surgery Risk Calculator and 33% more likely to predict correctly compared with the ASA score and Surgical Risk Scale.
Our study presents a validated preoperative mortality score for very elderly patients needing an emergency colectomy. The greater discriminating power of this targeted score indicates that preoperative risk assessment may need to be customized to specific procedures and patient circumstances.
尚不清楚术前风险预测是否会因使用更多针对患者和手术的模型而得到改善。我们为需要急诊结肠切除术的 80 岁及以上患者创建了一个定制的术前死亡率风险预测评分，并将其与现有的、更通用的风险评估方法进行了比较。
使用 2007 年至 2008 年美国外科医师学会全国外科质量改进计划（ACS NSQIP）数据创建了一个针对性的死亡率预测模型，并使用 2005 年至 2006 年的数据进行了验证。我们从确定的显著预测因素中构建了评分系统。比较了我们的目标评分与美国麻醉师协会（ASA）评分、手术风险评分和 ACS 结直肠手术风险计算器的模型拟合度。
分析在训练和验证样本中分别确定了 1358 例和 372 例急诊结肠切除术。我们的针对性风险预测评分具有良好的拟合优度 p 值（表示拟合良好）和 0.77 的 c 统计量，与 ASA 评分、手术风险评分和 ACS 结直肠手术风险计算器的 c 统计量（分别为 0.66、0.66 和 0.71）相比，具有显著更好的拟合度。当使用评分以 80%的特异性预测死亡率时，我们的针对性风险预测评分预测正确的可能性比 ACS 结直肠手术风险计算器高 25%，比 ASA 评分和手术风险评分高 33%。
我们的研究提出了一种针对需要急诊结肠切除术的非常老年患者的验证性术前死亡率评分。该针对性评分的更高区分能力表明，术前风险评估可能需要针对特定手术和患者情况进行定制。
