Copeland G P, Edwards P, Wilcox A, Wake P N, Harris P L
Warrington Hospital NHS Trust, Liverpool.
Ann R Coll Surg Engl. 1994 Mar;76(2):132-5.
Auditing the outcome from vascular surgery with regard to graft occlusion is made difficult by variations in the type of surgery performed and the case mix. These difficulties are compounded when attempting to compare units. In the present study we have attempted to develop a scoring system to predict the risk of graft occlusion, and thus compensate for these variables. Prospectively collected data from 214 consecutive patients undergoing vascular reconstructive surgery (233 arterial grafts) were analysed. Graft occlusion occurred in 82 patients (35.2%). Using a multivariate linear regression analysis of these data a five-factor, five-grade scoring system has been devised (GORA: Graft Occlusive Risk Assessment). Logistic regression analysis of the observed risk of occlusion with this derived score produced the following relationship between the odds ratio of occlusive risk and GORA score: (logeR/1 - R = (0.229 x score) - 4.165). The score was then validated in a different group of 186 patients (196 arterial grafts). In both groups the score was found to predict accurately the risk of graft occlusion (P < 0.001). There was no significant difference in the receiver operating characteristic curves between the estimation and validation groups.
由于所施行手术类型和病例组合的差异，对血管外科手术中移植物闭塞的结果进行审计存在困难。在试图比较各个单位时，这些困难变得更加复杂。在本研究中，我们试图开发一种评分系统来预测移植物闭塞的风险，从而弥补这些变量的影响。对前瞻性收集的214例连续接受血管重建手术患者（233条动脉移植物）的数据进行了分析。82例患者（35.2%）发生了移植物闭塞。通过对这些数据进行多变量线性回归分析，设计了一种五因素、五级评分系统（GORA：移植物闭塞风险评估）。用得出的这个分数对观察到的闭塞风险进行逻辑回归分析，得出闭塞风险比值比与GORA评分之间的如下关系：（logeR/1 - R = (0.229 x 评分) - 4.165）。然后在另一组186例患者（196条动脉移植物）中对该评分进行验证。在两组中均发现该评分能准确预测移植物闭塞的风险（P < 0.001）。估计组和验证组之间的受试者工作特征曲线无显著差异。
