Department of Orthopedics, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
Center for Experimental Medicine, Third Xiangya Hospital of Central South University, No.138 Tongzipo Road, Changsha, 410013, Hunan, China.
J Orthop Surg Res. 2022 May 7;17(1):255. doi: 10.1186/s13018-022-03134-0.
Since Mohamed et al. analyzed 2326 orthopedic cases in 2002 and believed that the POSSUM formula can be directly used to predict postoperative morbidity and mortality in orthopedic patients, applications of POSSUM and P-POSSUM scores in the hip fracture surgery have been mostly reported in the field of orthopedics, but there are still some inconsistencies in the related reports.
The electronic library was searched for all literature that met the purpose from its inception to 2021. Relative risk (RR) was selected to evaluate whether the model could be used to assess the risk of surgery in patients with elderly hip fractures. Finally, sensitivity analyses and subgroup analyses were performed.
Thirteen studies were finally included, including 9 retrospective and 4 prospective studies.The morbidity analysis includes 11 studies, and the result was RR = 1.07 (95% CI 0.93-1.24), The mortality analysis includes 11 studies on POSSUM and 5 studies on P-POSSUM. The results of mortality by POSSUM and by P-POSSUM were RR = 1.93 (95% CI 1.21-3.08) and RR = 1.15 (95% CI 0.89-1.50), respectively. POSSUM had more accuracy to predict mortality for sample < 200 subgroup(RR = 2.45; 95% CI 0.71-8.42) than sample > 200 subgroup(RR = 1.59; 95% CI 1.06-2.40), and in the subgroup of hip fractures that did not distinguish between specific fracture types(RR = 1.69, 95% CI 0.87-3.32) than intertrochanteric neck fracture subgroup(RR = 5.04, 95% CI 1.07-23.75) and femoral femoral fracture subgroup(RR = 1.43,95% CI 1.10-1.84).
POSSUM can be used to predict morbidity in elderly hip fractures. The P-POSSUM was more accurate in predicting mortality in elderly hip fracture patients compared to the POSSUM, whose predictive value for mortality was influenced by the sample size and type of fracture studied. In addition, we believe that appropriate improvements to the POSSUM system are needed to address the characteristics of orthopedic surgery.
自 Mohamed 等人在 2002 年分析了 2326 例骨科病例并认为 POSSUM 公式可直接用于预测骨科患者术后发病率和死亡率以来，POSSUM 和 P-POSSUM 评分在髋部骨折手术中的应用主要在骨科领域得到了报道，但相关报道仍存在一些不一致之处。
从成立之初到 2021 年，对所有符合目的的文献进行了电子文库检索。选择相对风险（RR）来评估模型是否可用于评估老年髋部骨折患者手术的风险。最后进行敏感性分析和亚组分析。
最终纳入了 13 项研究，包括 9 项回顾性研究和 4 项前瞻性研究。发病率分析包括 11 项研究，结果为 RR=1.07（95%CI 0.93-1.24）；死亡率分析包括 11 项 POSSUM 研究和 5 项 P-POSSUM 研究。POSSUM 和 P-POSSUM 的死亡率结果分别为 RR=1.93（95%CI 1.21-3.08）和 RR=1.15（95%CI 0.89-1.50）。POSSUM 对<200 例样本（RR=2.45；95%CI 0.71-8.42）的死亡率预测准确性高于>200 例样本（RR=1.59；95%CI 1.06-2.40），并且在未区分特定骨折类型的髋部骨折亚组（RR=1.69，95%CI 0.87-3.32）中准确性高于转子间骨折亚组（RR=5.04，95%CI 1.07-23.75）和股骨骨折亚组（RR=1.43，95%CI 1.10-1.84）。
POSSUM 可用于预测老年髋部骨折的发病率。与 POSSUM 相比，P-POSSUM 更能准确预测老年髋部骨折患者的死亡率，其死亡率的预测价值受研究样本量和骨折类型的影响。此外，我们认为需要对 POSSUM 系统进行适当改进，以解决骨科手术的特点。
