Sagar P M, Hartley M N, Mancey-Jones B, Sedman P C, May J, Macfie J
University Department of Surgery, Royal Liverpool Hospital, UK.
Br J Surg. 1994 Oct;81(10):1492-4. doi: 10.1002/bjs.1800811031.
Comparison of outcome after colorectal resection between different surgical units is difficult. Crude rates of morbidity and mortality may give a distorted picture as such rates fail to account for variations in case mix and physiological status of patients. The simple and validated scoring system POSSUM (Physiological and Operative Severity Score for enUmeration of Mortality and morbidity) was used to compare outcome after colorectal resection in two units. Consecutive series of patients who underwent colorectal resection in unit 1 (a university teaching hospital) or unit 2 (a district general hospital) were scored with the POSSUM system. Postoperative complications and 30-day mortality were recorded. In unit 1, 66 patients underwent colorectal resection with a mortality rate of 6 per cent and a morbidity rate of 9 per cent. In unit 2 the rates of mortality and morbidity were 9 and 26 per cent respectively for 182 patients undergoing colorectal resection. However, application of POSSUM predicted a mortality rate of 5.2 per cent for patients in unit 1 and 9.8 per cent for those in unit 2 with predicted morbidity rates of 11.2 and 23.9 per cent respectively. Direct comparison of outcome between these two units would be misleading. Application of POSSUM allows more realistic comparative audit of colorectal resection.
不同外科科室结直肠切除术后的结果比较存在困难。发病率和死亡率的原始数据可能会给出失真的情况，因为这些数据未能考虑到病例组合和患者生理状况的差异。使用简单且经过验证的评分系统POSSUM（用于计算死亡率和发病率的生理和手术严重程度评分）来比较两个科室结直肠切除术后的结果。对在科室1（一家大学教学医院）或科室2（一家地区综合医院）接受结直肠切除术的连续系列患者使用POSSUM系统进行评分。记录术后并发症和30天死亡率。在科室1，66例患者接受了结直肠切除术，死亡率为6%，发病率为9%。在科室2，182例接受结直肠切除术的患者的死亡率和发病率分别为9%和26%。然而，应用POSSUM预测科室1患者的死亡率为5.2%，科室2患者的死亡率为9.8%，预测发病率分别为11.2%和23.9%。这两个科室之间结果的直接比较会产生误导。应用POSSUM可以对结直肠切除术进行更实际的比较性审计。
