Schwilk B, Muche R, Treiber H, Brinkmann A, Georgieff M, Bothner U
Department of Anaesthesiology, University of Ulm, Germany.
J Clin Monit Comput. 1998 May;14(4):283-94. doi: 10.1023/a:1009916822005.
To develop a severity index of anaesthetic risk that predicts relevant perioperative adverse events in adults.
Prospective cross-sectional study.
Department of anaesthesiology at one university hospital.
26907 consecutive anaesthetic procedures in patients over 15 years of age and a complete preoperative evaluation. Patients undergoing cardiac and obstetric surgery were excluded.
Demographic data, preoperative health status, type of anaesthesia, operative procedures, and perioperative incidents (standardised on a national basis) were acquired by means of a computerised anaesthetic record system. Occurrence of at least one perioperative event with impact on postanaesthetic care was computed by a multivariate logistic regression model against 17 variables with different characteristics representing possible risk factors. Fourteen variables proved to be independent risk factors. The weighting of the variables was expressed in scores which added up to form a simple index for each patient. Patients without major risk factors (0-10 points) had a 0.3% risk of suffering from a relevant incident. Patients with more than 60 points had a 28.6% risk. The results were well demonstrated by cross-validation.
The index seems to reflect the risk of relevant perioperative incidents. It can be used for audit purposes. In daily routine, the index could focus our attention on patients with increased perioperative risk. However, it is limited in detecting particular constellations of factors which interact on each other with regard to perioperative risk.
制定一种麻醉风险严重程度指数，以预测成人围手术期相关不良事件。
前瞻性横断面研究。
一所大学医院的麻醉科。
对15岁以上患者连续进行26907例麻醉手术，并进行完整的术前评估。排除接受心脏和产科手术的患者。
通过计算机化麻醉记录系统获取人口统计学数据、术前健康状况、麻醉类型、手术操作和围手术期事件（全国标准化）。采用多因素逻辑回归模型，针对代表可能危险因素的17个具有不同特征的变量，计算至少发生一次对麻醉后护理有影响的围手术期事件的发生率。14个变量被证明是独立危险因素。变量的权重以分数表示，这些分数相加形成每个患者的一个简单指数。无主要危险因素（0 - 10分）的患者发生相关事件的风险为0.3%。得分超过60分的患者风险为28.6%。交叉验证很好地证明了结果。
该指数似乎反映了围手术期相关事件的风险。可用于审计目的。在日常工作中，该指数可使我们将注意力集中在围手术期风险增加的患者身上。然而，在检测围手术期风险方面相互作用的特定因素组合时，它存在局限性。
