Teixeira Inês M, Teles Ana R, Castro José M, Azevedo Luís F, Mourão Joana B
Faculty of Medicine, University of Porto, Oporto, Portugal.
Department of Anaesthesiology, Hospital Centre of São João, EPE, Oporto, Portugal.
J Cardiothorac Vasc Anesth. 2018 Apr;32(2):960-967. doi: 10.1053/j.jvca.2017.08.036. Epub 2017 Aug 24.
POSSUM system is widely used and validated for 30-day mortality and morbidity prediction. The aim of this study was to evaluate the performance of five POSSUM's equations (POSSUM, P-POSSUM, V-POSSUM, V-POSSUM physiology and V-POSSUM Cambridge) on predicting 30-day mortality and morbidity in elderly patients undergoing major elective vascular surgery.
A retrospective longitudinal cohort study.
A study conducted at an University Hospital.
208 elderly patients (≥ 60 years) undergoing major elective vascular surgery.
Data collected from the clinical files included patient's characteristics, diagnosis, surgery, comorbidities, parameters from POSSUM score, 30, 60 and 90-day mortality and 30-day morbidity. POSSUM system's goodness-of-fit for predicting mortality and morbidity was assessed by Hosmer-Lemeshow test (H-L T) and Standardized Mortality/Morbidity Ratio (SMR) and discriminative ability by the area under the ROC curves (ROC-AUC). Patients' average age was 70.8 years, 81% males.
None.
The overall 30-day mortality rate was 2.97% (n=6) and 30-day morbidity was 29.2% (n=59). POSSUM, P-POSSUM, V-POSSUM, V-POSSUM physiology and V-POSSUM Cambridge equation predicted an overall of 29.1, 4.43, 15.3, 21.9 and 13.5 deaths, respectively. POSSUM morbidity equation predicted 105.0 complications. H-LT p-values were 0.001, 0.164, 0.208, 0.011, 0.331 and <0.001, respectively. SMRs and 95% confidence interval (CI) were 0.21[0.04-0.37], 1.35[0.27-2.44], 0.39[0.08-0.71], 0.27[0.06-0.49], 0.44[0.09-0.80] and 0.56[0.42-0.71], respectively. ROC-AUC and 95% CI were 0.72[0.49-0.95], 0.72[0.49-0.95], 0.73[0.51-0.94], 0.69[0.50-0.89], 0.72[0.52-0.92] and 0.71[0.63-0.79], respectively.
P-POSSUM had the best performance predicting 30-day mortality. All the other overestimated 30-day mortality. Prediction of morbidity was inadequate. POSSUM scoring models may not be robust tools for risk prediction in elderly patients undergoing major elective vascular surgery and need further calibration and discrimination.
POSSUM系统广泛应用于30天死亡率和发病率预测，并已得到验证。本研究旨在评估五个POSSUM方程（POSSUM、P-POSSUM、V-POSSUM、V-POSSUM生理学方程和V-POSSUM剑桥方程）在预测接受择期大血管手术老年患者30天死亡率和发病率方面的性能。
一项回顾性纵向队列研究。
在一家大学医院进行的研究。
208例接受择期大血管手术的老年患者（≥60岁）。
从临床病历中收集的数据包括患者特征、诊断、手术、合并症、POSSUM评分参数、30天、60天和90天死亡率以及30天发病率。通过Hosmer-Lemeshow检验（H-L T）和标准化死亡率/发病率比（SMR）评估POSSUM系统预测死亡率和发病率的拟合优度，通过ROC曲线下面积（ROC-AUC）评估判别能力。患者平均年龄为70.8岁，男性占81%。
无。
总体30天死亡率为2.97%（n = 6），30天发病率为29.2%（n = 59）。POSSUM、P-POSSUM、V-POSSUM、V-POSSUM生理学方程和V-POSSUM剑桥方程分别预测的死亡总数为29.1、4.43、15.3、21.9和13.5例。POSSUM发病率方程预测有105.0例并发症。H-L T的p值分别为0.001、0.164、0.208、0.011、0.331和<0.001。SMR及95%置信区间（CI）分别为0.21[0.04 - 0.37]、1.35[
