Cirugía General, Complejo Hospitalario de Navarra, España.
Cirugía General/ Jefe Unidad Hepatobiliopancreatic, Complejo Hospitalario de Navarra, España.
Rev Esp Enferm Dig. 2019 Sep;111(9):677-682. doi: 10.17235/reed.2019.6187/2019.
an increasing number of elderly patients undergo urgent abdominal surgery and this population has a higher risk of mortality. The main objective of the study was to identify mortality-associated factors in elderly patients undergoing abdominal surgery and to design a mortality scoring tool, the Urgent Surgery Elderly Mortality risk score (the USEM score).
this was a retrospective study using a prospective database. Patients > 65 years old that underwent urgent abdominal surgery were included. Risk factors for 30-day mortality were identified using multivariate regression analysis and weights assigned using the odds ratios (OR). A mortality score was derived from the aggregate of weighted scores. Model calibration and discrimination were judged using the receiver operating characteristics curves and the Hosmer-Lemeshow test.
in the present study, 4,255 patients were included with an 8.5% mortality rate. The risk factors significantly associated with mortality were American Society of Anesthesiologists (ASA) score, age, preoperative diagnosis (OR: 37.82 for intestinal ischemia, OR: 5.01 for colorectal perforation, OR: 6.73 for intestinal obstruction), surgical wound classification and open or laparoscopic surgery. A risk score was devised from these data for the estimation of the probability of survival in each patient. The area under the ROC curve (AUROC) for this score was 0.84 (95% CI: 0.82-0.86) and the AUROC correct was 0.83 (0.81-0.85).
a simple score that uses five clinical variables predicts 30-day mortality. This model can assist surgeons in the initial evaluation of an elderly patient undergoing urgent abdominal surgery.
越来越多的老年患者接受紧急腹部手术，此类人群的死亡率更高。本研究的主要目的是确定接受腹部手术的老年患者的死亡相关因素，并设计一种死亡率评分工具，即紧急手术老年死亡率风险评分（Urgent Surgery Elderly Mortality risk score，USEM 评分）。
这是一项回顾性研究，使用前瞻性数据库。纳入年龄>65 岁且接受紧急腹部手术的患者。使用多变量回归分析确定 30 天死亡率的危险因素，并使用优势比（odds ratio，OR）分配权重。从加权分数的总和中得出死亡率评分。使用接收者操作特征曲线和 Hosmer-Lemeshow 检验来判断模型校准和区分度。
本研究共纳入 4255 例患者，死亡率为 8.5%。与死亡率显著相关的危险因素包括美国麻醉医师协会（American Society of Anesthesiologists，ASA）评分、年龄、术前诊断（肠缺血的 OR：37.82，结直肠穿孔的 OR：5.01，肠梗阻的 OR：6.73）、手术切口分类以及开放性或腹腔镜手术。根据这些数据制定了一个风险评分，用于估计每位患者的生存概率。该评分的 ROC 曲线下面积（area under the ROC curve，AUROC）为 0.84（95%置信区间：0.82-0.86），AUROC 校正值为 0.83（0.81-0.85）。
一个使用五个临床变量的简单评分可预测 30 天死亡率。该模型可以帮助外科医生对接受紧急腹部手术的老年患者进行初步评估。
