Korenkov M, Gundlach M, Heimbucher J, Saad S, Troidl H, Zühlke H
Abteilung für Allgemein-und Visceralchirurgie, Klinikum Werra-Meißner, Elsa-Brändström-Str. 1, 37269, Eschwege, Deutschland,
Chirurg. 2014 Nov;85(11):999-1004. doi: 10.1007/s00104-013-2702-x.
This study examined the validity of the classification of intraoperative difficulties and its usefulness in surgical practice.
Data on general surgical patients were collected in four German hospitals within a multicentre validation study. Before and immediately after surgery, the operating surgeon rated the relative difficulty of the operation using a score of 1 (easy), 2 (not easy), 3 (difficult) and 4 (very difficult). Data on the duration of surgery and on the occurrence of intraoperative and postoperative complications were collected. Multivariate regression models were constructed to examine whether different clinical variables and the surgeon's preoperative assessment of surgical difficulty increased the power of the prognostic model. The R(2) statistics, which describe explained variance (EV) as a percentage was used to compare regression models.
From July 2010 to August 2011 overall 500 patients were analyzed. Most patients were classified as being ideal (30 %) or relatively ideal (49 %) candidates for surgery. Preoperative and postoperative classification results were identical in 64 % of patients and were partly determined by classical risk factors (ASA score, number of previous surgeries, type of surgery, body mass index and gender). The addition of the surgeon's risk estimation to the multivariate models improved the prediction of duration of surgery (from 41.4% to 45.5 % EV), complications (from 22.5% to 24.5 % EV) and length of stay (from 32.6% to 34.5 % EV).
The classification of intraoperative difficulty can be applicable in surgical daily practice in terms of surgical decision-making in difficult intraoperative situations as well as in operating room management. It could also be useful for other surgical disciplines.
本研究检验了术中困难分类的有效性及其在外科手术实践中的实用性。
在一项多中心验证研究中，收集了德国四家医院普外科患者的数据。手术前及手术结束后，主刀医生使用1分（容易）、2分（不容易）、3分（困难）和4分（非常困难）对手术的相对难度进行评分。收集了手术时长、术中及术后并发症发生情况的数据。构建多变量回归模型，以检验不同临床变量及外科医生术前对手术难度的评估是否能增强预后模型的预测能力。使用R²统计量（将解释方差（EV）描述为百分比）来比较回归模型。
2010年7月至2011年8月，共分析了500例患者。大多数患者被归类为手术的理想候选人（30%）或相对理想候选人（49%）。64%的患者术前和术后分类结果相同，且部分由经典风险因素（美国麻醉医师协会（ASA）评分、既往手术次数、手术类型、体重指数和性别）决定。将外科医生的风险评估加入多变量模型后，改善了对手术时长（从41.4%的解释方差提高到45.5%）、并发症（从22.5%提高到24.5%）和住院时长（从32.6%提高到34.5%）的预测。
术中困难分类在外科手术日常实践中，对于困难术中情况的手术决策以及手术室管理均适用。它对其他外科领域可能也有用。
