人与机器的较量——手术风险评估的差异。一项队列前瞻性研究。

Man against the machine - Differences in surgical risk evaluation. A cohort prospective study.

机构信息

Department of Otolaryngology Head and Neck Surgery, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.

Department of Anesthesia, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.

出版信息

Int J Surg. 2018 Dec;60:252-256. doi: 10.1016/j.ijsu.2018.11.012. Epub 2018 Nov 22.

DOI:10.1016/j.ijsu.2018.11.012

PMID:30471366

Abstract

BACKGROUND

The aim of this study was to compare the assessment provided by the ACS Surgical Risk Calculator with the assessments provided by senior and resident anesthesiologists.

METHODS

The study is prospective and controlled. Before the surgical procedure a resident anesthesiologist collected data needed to perform pre-operative assessment. Then, based on this data, a risk assessment was carried out by resident and senior anesthesiologists and by the online ACS Surgical Risk Calculator. Then the three evaluations were compared. Demographic and clinical data were gathered to determine risk factors and complication rates.

RESULTS

One hundred patients who were scheduled for a surgical procedure were recruited for the study. A difference was found among the different estimations. In most parameters the resident anesthesiologists more resembled the ACS assessment than the senior anesthesiologists. The following differences in risk assessment were found: possible complication in the course of the surgery (4.4% ACS calculator, 1% senior anesthesiologists, 2.2% resident anesthesiologists), and for a life-threatening complication (3.6% ACS calculator, 0.5% senior anesthesiologists, 2.4% resident anesthesiologists). In assessing death, urinary tract and surgical sites infections the seniors difference to the ACS calculator was statistically significant (p < 0.05). Seniors resembled better cardiac complications (p < 0.05) and both resident and senior anesthesiologists failed to resemble the ACS calculator in assessing return to the operating room and pneumonia (p < 0.05).

CONCLUSIONS

Both senior and resident anesthesiologists failed to estimate the surgical risks based on preoperative data. Further study involving the surgeons and comparing the estimated to the actual complication rates are needed.

摘要

背景

本研究旨在比较 ACS 外科风险计算器提供的评估与高级和住院麻醉师提供的评估。

方法

该研究是前瞻性和对照性的。在手术前，住院麻醉师收集进行术前评估所需的数据。然后，根据这些数据，由住院和高级麻醉师以及在线 ACS 外科风险计算器进行风险评估。然后比较这三种评估。收集人口统计学和临床数据以确定危险因素和并发症发生率。

结果

本研究共招募了 100 名计划进行手术的患者。不同评估之间存在差异。在大多数参数中，住院麻醉师的评估更类似于 ACS 评估，而不是高级麻醉师的评估。在风险评估方面发现了以下差异：手术过程中可能发生的并发症（4.4%ACS 计算器，1%高级麻醉师，2.2%住院麻醉师），危及生命的并发症（3.6%ACS 计算器，0.5%高级麻醉师，2.4%住院麻醉师）。在评估死亡、尿路感染和手术部位感染方面，高级麻醉师与 ACS 计算器的差异具有统计学意义（p<0.05）。高级麻醉师更能预测心脏并发症（p<0.05），而住院和高级麻醉师都未能像 ACS 计算器那样预测返回手术室和肺炎（p<0.05）。