Junod F L, Harlan B J, Payne J, Smeloff E A, Miller G E, Kelly P B, Ross K A, Shankar K G, McDermott J P
Ann Thorac Surg. 1987 Jan;43(1):59-64. doi: 10.1016/s0003-4975(10)60167-1.
In the present climate of quality-assurance policies, rigorous requirements for informed consent, and a constantly changing patient population, a system of preoperative risk assignment and postoperative correlation was developed to monitor and evaluate surgical performance. Patients were categorized by operation, priority (emergent, urgent, elective), New York Heart Association Functional Class, and risk. Risk was assigned before operation using data from the Coronary Artery Surgery Study (CASS) and the recent literature. Data were collected by a full-time data manager and were stored and analyzed by computer. From January 1, 1984, to July 1, 1985, 1,303 patients underwent operation for acquired disease. This group included 913 patients undergoing isolated primary coronary artery bypass grafting (CABG). The comparison of predicted and observed results showed: (Table: see text). For patients undergoing isolated primary CABG, the elective group had an operative mortality of 0.6% (2/329); the urgent group, 1.1% (5/450); and the emergent group, 5.2% (7/134). Preoperative risk assignment is an effective method of quality assurance. Female sex and age older than 60 years, which predicted an operative mortality of 2 to 5% in the CASS study and other recent series, did not predict a similar risk in our series.
在当前质量保证政策、严格的知情同意要求以及不断变化的患者群体的环境下，开发了一种术前风险评估和术后相关性系统，以监测和评估手术表现。患者按手术类型、优先级（急诊、 urgent、 elective）、纽约心脏协会功能分级和风险进行分类。术前使用来自冠状动脉手术研究（CASS）和近期文献的数据进行风险评估。数据由一名全职数据管理员收集，并通过计算机存储和分析。从1984年1月1日至1985年7月1日，1303例患者因后天性疾病接受手术。该组包括913例接受单纯原发性冠状动脉旁路移植术（CABG）的患者。预测结果与观察结果的比较显示：（表格：见原文）。对于接受单纯原发性CABG的患者，择期组手术死亡率为0.6%（2/329）； urgent组为1.1%（5/450）；急诊组为5.2%（7/134）。术前风险评估是质量保证的有效方法。在CASS研究和其他近期系列研究中预测手术死亡率为2%至5%的女性和60岁以上的年龄，在我们的系列研究中并未预测出类似风险。 （注：urgent此处翻译存疑，原文表述不完整准确）
