Eur J Trauma Emerg Surg. 2014 Oct;40(5):617-24. doi: 10.1007/s00068-014-0399-2. Epub 2014 May 27.
The Royal College of Surgeons of England (RCS) published guidance in 2011 setting standards for the management of emergency surgical patients with the aim of reducing surgical mortality. These suggested the presence of a consultant surgeon and anaesthetist, and transfer to a higher level of care postoperatively for all patients deemed high risk.
This prospective multi-institutional study sought to evaluate whether adherence to these standards was associated with reduced mortality.
Data were prospectively collected on all emergency general surgery operations performed in emergency theatres across Merseyside, UK, during a 30-day period in September-October 2011. Patients were risk assessed using P-POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity). High-risk patients were classified as those with a P-POSSUM predicted mortality of ≥10 %, and moderate-risk patients as those with a P-POSSUM predicted mortality of 5-10 %.
Some 494 procedures were performed on 471 patients. Twenty-four patients (5 %) died within 30 days of surgery. Mortality in the 65 patients identified as high risk was 27 % (14 patients undergoing 17 procedures), with a consultant surgeon present in 46 of 65 high-risk cases (71 %), a consultant anaesthetist in 43 (66 %), and 46 (71 %) cases were admitted to level 2 or 3 care postoperatively. There was no association between adherence to standards and postoperative mortality in either the whole cohort or specifically the high-risk group.
There is currently incomplete adherence to the national guidelines, but this does not seem to adversely impact postoperative mortality.
英国皇家外科医学院（RCS）于2011年发布了指南，为急诊外科患者的管理设定标准，旨在降低手术死亡率。这些标准建议配备外科顾问医师和麻醉医师，并将所有被视为高风险的患者术后转至更高水平的护理机构。
这项前瞻性多机构研究旨在评估遵守这些标准是否与降低死亡率相关。
前瞻性收集了2011年9月至10月期间在英国默西塞德郡各急诊手术室进行的所有急诊普通外科手术的数据。使用P-POSSUM（死亡率和发病率评估的生理和手术严重程度评分）对患者进行风险评估。高风险患者被定义为P-POSSUM预测死亡率≥10%的患者，中度风险患者为P-POSSUM预测死亡率为5%-10%的患者。
共对471例患者进行了约494例手术。24例患者（5%）在术后30天内死亡。在被确定为高风险的65例患者中，死亡率为27%（14例患者接受了17例手术），65例高风险病例中有46例（71%）有外科顾问医师在场，43例（66%）有麻醉顾问医师在场，46例（71%）病例术后被收治到二级或三级护理机构。在整个队列或特定的高风险组中，遵守标准与术后死亡率之间均无关联。
目前对国家指南的遵守情况并不完全，但这似乎并未对术后死亡率产生不利影响。
