Copeland G P, Jones D, Wilcox A, Harris P L
Warrington District General Hospital.
Ann R Coll Surg Engl. 1993 May;75(3):175-7.
Comparative audit using overall mortality and morbidity figures can be misleading as they do not take into account variations in surgical procedure and patient fitness. To examine these effects we have compared vascular surgery in two differing hospitals, during a similar 9-month period, using the POSSUM scoring system. In one unit, 255 patients underwent vascular surgery with an operative mortality of 9.4%, and morbidity of 37.3%. In the other unit, 89 patients underwent vascular procedures with an operative mortality of 20.2% and morbidity of 47.2%. At first sight there appear to be significant differences in operative outcome between the two units. However, analysis using the POSSUM system predicts a mortality rate of 10.2% for unit A and 20.2% for unit B (morbidity rates of 38.4% for unit A and 50.6% for unit B). Receiver operating curve (ROC) analysis demonstrated no significant difference between the two units (see Table III). POSSUM analysis may be of use in comparative audit.
使用总体死亡率和发病率数据进行比较性审计可能会产生误导，因为这些数据没有考虑手术程序和患者健康状况的差异。为了研究这些影响，我们在相似的9个月期间，使用POSSUM评分系统对两家不同医院的血管外科手术进行了比较。在一个科室，255例患者接受了血管外科手术，手术死亡率为9.4%，发病率为37.3%。在另一个科室，89例患者接受了血管手术，手术死亡率为20.2%，发病率为47.2%。乍一看，两个科室的手术结果似乎存在显著差异。然而，使用POSSUM系统进行分析预测，A科室的死亡率为10.2%，B科室为20.2%（A科室的发病率为38.4%，B科室为50.6%）。受试者工作特征曲线（ROC）分析表明两个科室之间没有显著差异（见表III）。POSSUM分析可能在比较性审计中有用。
