Mukherjee Sudipta, Kedia Ankit, Goswami Jyotsna, Chakraborty Arunangshu
Department of Anaesthesia, Critical Care and Pain, Tata Medical Center, Kolkata, West Bengal, India.
J Anaesthesiol Clin Pharmacol. 2022 Jan-Mar;38(1):61-65. doi: 10.4103/joacp.JOACP_128_20. Epub 2022 Apr 25.
Objective prediction of postoperative morbidity and mortality can help clinicians for appropriate resource allocation and counseling of patients and their kin. Among different scoring systems, "Portsmouth- Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity" (P-POSSUM) includes both preoperative and intraoperative parameters for postoperative risk prediction. The aim of this study was to investigate the validity of morbidity prediction by P-POSSUM in patients requiring intensive care after undergoing major surgeries for gastrointestinal and gynecological malignancies.
All adult patients (>18 years) undergoing gastrointestinal and gynecological cancer surgeries who were shifted to intensive care unit (ICU) or high dependency unit (HDU) for postoperative care were included and P-POSSUM was measured. Postoperative complications were graded as per Clavien-Dindo (CD) grading and have been compared with predicted complications as per P-POSSUM.
143 patients were included in the study and the median P-POSSUM score was 35. The mean predicted morbidity was 55.28% (SD 25.54%) and the observed complications were 45.45%, which shows P- POSSUM has over predicted morbidity. At P-POSSUM values 60 and above, the incidence of major complications was 22.22%, compared to 6.25% for the rest (Odds ratio 4.286).
P-POSSUM is not a reliable predictor of postoperative morbidity for patients undergoing major gynecological and gastrointestinal surgeries for cancer in our institution. But there is a significant incidence of major complications with P- POSSUM morbidity prediction score 60 or higher leading to the need for more stringent assessment and monitoring in that subgroup.
对术后发病率和死亡率进行客观预测有助于临床医生进行合理的资源分配，并为患者及其家属提供咨询。在不同的评分系统中，“朴茨茅斯-死亡率和发病率枚举的生理与手术严重程度评分”（P-POSSUM）包括术前和术中参数用于术后风险预测。本研究的目的是调查P-POSSUM在接受胃肠道和妇科恶性肿瘤大手术后需要重症监护的患者中对发病率预测的有效性。
纳入所有接受胃肠道和妇科癌症手术且术后转入重症监护病房（ICU）或高依赖病房（HDU）进行护理的成年患者（>18岁），并测量P-POSSUM。术后并发症根据Clavien-Dindo（CD）分级进行评分，并与P-POSSUM预测的并发症进行比较。
143例患者纳入本研究，P-POSSUM评分中位数为35。平均预测发病率为55.28%（标准差25.54%），观察到的并发症为45.45%，这表明P-POSSUM对发病率的预测过高。在P-POSSUM值为60及以上时，主要并发症的发生率为22.22%，其余为6.25%（比值比4.286）。
在我们机构中，P-POSSUM对于接受妇科和胃肠道癌症大手术的患者并非术后发病率的可靠预测指标。但P-POSSUM发病率预测评分60或更高时，主要并发症的发生率显著升高，这导致需要对该亚组进行更严格的评估和监测。
