用于评估患者预后以及外科医生和麻醉医生在肝胆胰外科手术中表现的死亡率和发病率评分系统的生理和手术严重程度评分。

Physiological and operative severity score for the enumeration of mortality and morbidity scoring systems for assessment of patient outcome and impact of surgeons' and anesthesiologists' performance in hepatopancreaticobiliary surgery.

作者信息

Fassoulaki Argyro, Chondrogiannis Konstantinos, Staikou Chryssoula

机构信息

Department of Anesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece.

出版信息

Saudi J Anaesth. 2017 Apr-Jun;11(2):190-195. doi: 10.4103/1658-354X.203025.

DOI:10.4103/1658-354X.203025

PMID:28442958

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5389238/

Abstract

CONTEXT

The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system used to predict morbidity and mortality.

AIMS

We compared the physiological and operative risk, the expected morbidity and mortality, and the observed postoperative mortality among patients operated by different surgeons and anesthetized by different anesthesiologists.

SETTINGS AND DESIGN

This was a retrospective, single center study.

SUBJECTS AND METHODS

The anesthetic records of 159 patients who underwent hepatopancreaticobiliary surgery were analyzed for the physiological and operative severity, POSSUM morbidity, POSSUM and Portsmouth POSSUM (P-POSSUM) mortality scoring systems, observed mortality in 30-days, 3, 6, and 12 months postoperatively, duration of surgery, and units of packed red blood cells (PRBC) transfused. These variables were compared among patients operated by five different surgeons and anesthetized by seven different anesthesiologists.

STATISTICAL ANALYSIS

One-way analysis of variance was used for normally and Kruskal-Wallis test for nonnormally distributed responses. Differences in percentages of postoperative mortality were assessed by Chi-squared test.

RESULTS

The physiological severity, POSSUM morbidity, POSSUM and P-POSSUM mortality scores, and observed mortality at 1, 3, 6, and 12 months postoperatively did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. Duration of surgery ( < 0.001), PRBC units transfused ( = 0.002), and operative severity ( = 0.001) differed significantly among patients operated by different surgeons.

CONCLUSIONS

The physiological severity score, POSSUM and P-POSSUM scores did not differ among patients operated by different surgeons and anesthetized by different anesthesiologists. The different operative severity scores did not influence the observed mortality in the postoperative period.

摘要

背景

用于计算死亡率和发病率的生理与手术严重程度评分系统（POSSUM）是一种用于预测发病率和死亡率的评分系统。

目的

我们比较了由不同外科医生手术、不同麻醉医生麻醉的患者的生理和手术风险、预期发病率和死亡率以及观察到的术后死亡率。

设置与设计

这是一项回顾性单中心研究。

研究对象与方法

分析了159例行肝胰胆手术患者的麻醉记录，包括生理和手术严重程度、POSSUM发病率、POSSUM和朴茨茅斯POSSUM（P-POSSUM）死亡率评分系统、术后30天、3个月、6个月和12个月的观察死亡率、手术时长以及输注的浓缩红细胞（PRBC）单位数。对由5名不同外科医生手术、7名不同麻醉医生麻醉的患者的这些变量进行了比较。

统计分析

对于呈正态分布的反应，采用单因素方差分析；对于非正态分布的反应，采用Kruskal-Wallis检验。通过卡方检验评估术后死亡率百分比的差异。

结果

由不同外科医生手术、不同麻醉医生麻醉的患者，其生理严重程度、POSSUM发病率、POSSUM和P-POSSUM死亡率评分以及术后1个月、3个月、6个月和12个月的观察死亡率并无差异。不同外科医生手术的患者，其手术时长（<0.001）、输注的PRBC单位数（=0.002）和手术严重程度（=0.001）存在显著差异。