Yamamoto Ryo, Hirakawa Shinya, Tachimori Hisateru, Matsuoka Tadashi, Kikuchi Hirotoshi, Hasegawa Hiroshi, Shirabe Ken, Kakeji Yoshihiro, Kawakubo Hirofumi, Kitagawa Yuko, Sasaki Junichi
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku.
Endowed Course for Health System Innovation, Keio University School of Medicine.
Int J Surg. 2024 Nov 1;110(11):7134-7141. doi: 10.1097/JS9.0000000000002037.
Perforated peptic ulcer (PPU) causes peritonitis and requires surgery based on disease severity. This study aimed to develop and validate a severity scale for PPU with generalized peritonitis.
This retrospective cohort study used a nationwide multicenter surgical database (2013-2020). Patients aged >15 years who underwent surgery for PPU with generalized peritonitis were included and categorized into the derivation (2013-2018) and two validation (2019 and 2020) cohorts. Possible severity predictors were selected via a literature review, and Lasso models were developed to predict severe postoperative adverse events with 2000 bootstrapping. Final variables for the scoring system were determined based on inclusion frequency (≥90%) in the Lasso models. Discrimination and accuracy were evaluated using C-statistics and calibration plots. Cutoff values for minimal postoperative adverse events were examined using negative predictive values.
Among 12 513 patients included (1202 underwent laparoscopic surgery), 533 (5.9%), 138 (7.6%), and 117 (6.9%) in the derivation and two validation cohorts experienced postoperative adverse events. Age, dyspnea at rest, preoperative sepsis, III/IV/V of American Society of Anesthesiologists physical status, and albumin and creatinine were selected for the final model. A 0-11 scoring system was developed with C-statistics of 0.812-0.819. Cutoff value was determined as 5, which predicted <3% probability of postoperative adverse events regardless of type of surgery.
A score of <5 predicts minimal risks for postoperative adverse events and, therefore, would be clinically useful to determine the type of surgery. Further studies are needed to validate the score.
穿孔性消化性溃疡（PPU）可导致腹膜炎，需根据疾病严重程度进行手术。本研究旨在开发并验证一种针对伴有弥漫性腹膜炎的PPU严重程度量表。
这项回顾性队列研究使用了一个全国性多中心外科数据库（2013 - 2020年）。纳入年龄大于15岁、因伴有弥漫性腹膜炎的PPU接受手术的患者，并将其分为推导队列（2013 - 2018年）和两个验证队列（2019年和2020年）。通过文献回顾选择可能的严重程度预测因素，并使用2000次自抽样开发套索模型以预测严重术后不良事件。评分系统的最终变量基于套索模型中的纳入频率（≥90%）确定。使用C统计量和校准图评估辨别力和准确性。使用阴性预测值检查术后最小不良事件的临界值。
在纳入的12513例患者中（1202例行腹腔镜手术），推导队列和两个验证队列中分别有533例（5.9%）、138例（7.6%）和117例（6.9%）发生术后不良事件。最终模型选择了年龄、静息时呼吸困难、术前脓毒症、美国麻醉医师协会身体状况分级III/IV/V级以及白蛋白和肌酐。开发了一个0 - 11分的评分系统，C统计量为0.812 - 0.819。临界值确定为5分，无论手术类型如何，该值预测术后不良事件的概率<3%。
评分<5分预测术后不良事件风险极小，因此在确定手术类型方面具有临床实用性。需要进一步研究来验证该评分。
