Seymour D G, Pringle R
Br Med J (Clin Res Ed). 1982 May 22;284(6328):1539-42. doi: 10.1136/bmj.284.6328.1539.
In a prospective study of 505 patients aged 65 years or over admitted to a general surgical unit the overall hospital mortality rate was 14.5% and the postoperative mortality rate 12.0%. These rates fell to 3.6% and 5.8% respectively when deaths in non-viable patients were excluded from the analysis. An audit of surgical outcome that fails to identify non-viable patients is therefore potentially misleading. A standardised system of reporting surgical mortality is proposed to aid the comparison of results from different units. The key elements of this system are (a) the separation of the results from non-viable and potentially viable patients; (b) the consideration of both operative and non-operative mortality; (c) the differentiation between medical and surgical causes of postoperative mortality; and (d) the identification of patients who are discharged from the unit but who have residual malignancy. Data presented in such a way should be of direct relevance to surgeons and physicians who are seeking ways of improving the service provided for surgical patients of all ages.
在一项针对505名65岁及以上入住普通外科病房患者的前瞻性研究中，总体医院死亡率为14.5%，术后死亡率为12.0%。若分析中排除无法存活患者的死亡情况，这些比率分别降至3.6%和5.8%。因此，一项未能识别无法存活患者的手术结果审计可能会产生误导。为便于比较不同科室的结果，提出了一种标准化的手术死亡率报告系统。该系统的关键要素包括：(a) 区分无法存活和可能存活患者的结果；(b) 考虑手术和非手术死亡率；(c) 区分术后死亡的医疗和手术原因；(d) 识别已从科室出院但仍有残余恶性肿瘤的患者。以这种方式呈现的数据应与寻求改善为各年龄段手术患者提供服务方式的外科医生和内科医生直接相关。
