POSSUM和P-POSSUM评分评价肠内营养对胃癌根治术后并发症率和死亡率的影响

目的　采用POSSUM和P POSSUM评分系统评估肠内营养对于胃癌根治术病人的手术并发症率和死亡率的影响。方法　回顾性分析 1 0 6例胃癌根治术病人的并发症率和死亡率 ,与POSSUM和P POSSUM评分预测的发生率进行比较。结果　肠内营养组实际并发症率为 2 .2 2 % ,无死亡病例 ;对照组实际并发症率为 1 6 .39% ,死亡率为 1 .6 4 %。肠内营养组病人的并发症率显著低于对照组 (P <0 .0 5 )。肠内营养组的实际并发症率和死亡率均显著低于预测发生率 ,P <0 .0 1。对照组实际并发症率和死亡率较POSSUM评分预测的发生率为低 ,P <0 .0 1 ,与P POSSUM评分预测校正后的死亡率无显著差异 (P >0 .0 5 )。结论　术后早期使用肠内营养可以降低胃癌根治术病人的并发症率和死亡率     

改良POSSUM评分系统在高龄普外科患者中的应用

目的评价改良POSSUM评分系统在高龄普外科病人中的应用价值。方法回顾性分析245例75岁以上的普外科手术病人的术后并发症率和死亡率，并与改良POSSUM评分系统预测的结果进行比较。结果改良POSSUM评分系统预测的并发症发生率为49.80％，死亡率为14.29％。实际并发症发生率为35.51％，死亡率为4.89％。结论在高危组病例中改良POSSUM评分系统更具有使用价值。     

改良POSSUM评分系统在预测老年人股骨粗隆间骨折手术风险中的应用价值

目的 探讨应用POSSUM评分系统预测老年人股骨粗降间骨折术后病死率及并发症发牛率的价值.方法 2007年1月至2008年12月回顾性分析119例老年股骨粗隆间骨折患者,按照适用于骨科的改良型POSSUM评分系统评估量表对每例患者进行生理学评分及手术严重度评分,将数据代人原始POSSUM回归公式计算出术后死亡概率及术后并发症发生概率,据此概率计算出预测死亡人数和发生并发症人数,并与观察到的实际死亡人数和发生并发症人数进行比较.结果 POSSUM评分系统预测术后30 d内42例(35.3%)发生并发症,实际发生并发症39例(32.8%),(χ2=0.168,P=0.682);预测术后30 d内死亡11例(9.2%),实际死亡5例(4.2%)(χ2=2.412,P=0.120).结论 改良POSSUM评分系统能较好的预测老年患者股骨粗隆间骨折术后30 d内的并发症发生率及病死率,对于高危患者(预测病死率>20%)的预测结果更加准确;其生理学评分量表可用于老年股骨粗隆间骨折患者的术前评估;肺部疾病是导致老年股骨粗隆间骨折患者术后死亡的首要因素.     

POSSUM及P-POSSUM对胃肠外科手术风险度的评价

目的探讨术前使用POSSUM和P-POSSUM评分系统对预测胃肠外科患者术后并发症和病死率的准确性。方法以POSSUM和P-POSSUM各项指标及常见临床影响因素为参考,对近1年内泸州医学院附属医院普外科收治的633例胃肠外科手术患者进行前瞻性的评估,并与患者实际并发症、死亡情况进行比较。以Logistic回归分析,非参数独立样本t检验,ROC曲线,预测和实际病死率及并发症符合度(OE比率)等统计学方法评价POSSUM及P-POSSUM预测的准确性。结果POSSUM预测并发症发生数为229例,实际发生数为188例;P-POSSUM预测死亡数为44例,实际死亡数为34例,差异均无统计学意义(P0.05);在高危机组(R138,R250)预测更具准确性,预测和实际病死率和并发症率符合度等于1;而在低危机组(R138,R250)则其死亡发生率被高估,预测和实际病死率和并发症率符合度大于1。多因素Logistic回归分析显示,肝功能、血糖、体高比、手术时间和术中血压的平稳因素与术后并发症和病死率均有相关性。结论对于胃肠外科患者,POSSUM预测其并发症率和P-POSSUM预测其病死率有良好的相关性。     

POSSUM评分预测胃肠道肿瘤患者术后并发症发生率和死亡率的价值

目的探讨POSSUM评分系统评估胃肠道肿瘤患者手术后并发症发生率和死亡率的临床价值。方法对171例胃肠道肿瘤患者分别在术后立即进行生理学和手术侵袭度评分,预测术后发生并发症和死亡的危险性,同时观察术后并发症发生率和死亡率的实际值,并与预测值进行比较。结果POSSUM评分预测并发症发生例数为75例,与实际并发症发生的96例比较,差异无显著性意义(P=0.3529)。POSSUM评分预测死亡例数为22例,与实际死亡的17例比较,差异也无显著性意义(P=0.3326)。结论POSSUM评分能较好地评估胃肠道肿瘤手术的预后。     

POSSUM评分系统预测胰十二指肠切除术手术风险的价值

目的 探讨POSSUM评分系统在预测胰十二指肠切除术(PD)手术风险中的价值.方法 采用POSSUM评分系统(含12项生理学指标和6项手术学指标)对2005年1月至2007年12月在四川大学华西医院肝胆胰外科接受PD手术的265例患者的资料前瞻性地进行评分,根据公式计算出预期术后并发症和术后病死率的发生情况;按Clavien术后并发症诊断标准和国内参考标准分别统计分析术后实际并发症的发生情况,并与预期并发症发生情况进行比较.结果 265例患者的生理学评分为12-24分,平均15分;手术学评分为14～24分,平均17分;POSSUM评分值为0.24～0.88分,预期平均并发症发生率为43.8%.发生例数为116例;实际观察有105例术后发生不同程度的并发症,实际并发症发生率为39.6%,与预测数比较差异无统计学意义(P>0.05).进一步的分层分析发现,POSSUM评分为0.4～0.8分时预测最为准确;POSSUM评分系统在预测术后总的病死率时价值不大,但对于POSSUM评分≥0.5分患者的病死率预测仍有意义.结论 POSSUM评分系统能较好地预测PD的手术风险,对于PD手术及术后处理决策有指导意义.     

POSSUM评分系统预测肝癌患者术后并发症发生率及病死率的意义

目的 :探讨POSSUM评分系统预测肝癌患者术后并发症发生率及病死率的临床意义。方法 :2009~2014年294例手术治疗的肝癌患者进行POSSUM及P-POSSUM评分,预测术后并发症发生率及病死率,并分别与实际并发症发生率及病死率比较。结果:POSSUM评分系统预测并发症发生率18%(53/294),实际发生率14%(42/294),差异无统计学意义(P=0.218),预测病死率5.1%(15/294),实际病死率1.02%(3/294),差异有统计学意义(P=0.004)。P-POSSUM预测病死率2.4%(7/294),实际病死率1.02%(3/294),差异无统计学意义(P=0.339)。结论:POSSUM评分系统能够较准确地预测肝癌患者术后并发症的发生率,但高估了术后病死率,P-POSSUM预测术后病死率更为准确。     

老年髋部骨折患者术前风险评估

背景:目前临床上有多种风险预测评估系统及相关危险因素,均可在一定程度上对患者的病情严重性进行客观评估,但尚无专门针对老年髋部骨折患者的手术风险预测系统。目的:比较老年髋部骨折患者手术风险评分系统(ORSSHF)与生理学和手术严重度评分系统(POSSUM),探索能客观而准确反映该类患者手术风险的预测方法。方法:依据统计学及POSSUM评分系统建立ORSSHF评分系统,分别应用ORSSHF和POSSUM评分系统回顾性研究2011年3月至2012年3月接受手术治疗的112例老年髋部骨折患者,男47例,女65例;年龄60～94岁,平均(74.6±6.8)岁。按术前风险评分进行分组,用统计学方法比较两种评分系统对该类患者手术并发症和死亡率的预测价值。结果:应用POSSUM和ORSSHF评分系统进行预测,发生并发症例数分别为50例和44例,死亡例数分别为6例和4例,实际发生并发症36例、死亡3例。前者预测值显著高于实际值(P<0.05);后者预测值和实际值无统计学差异。结论:POSSUM评分系统评估老年髋部骨折患者术前风险存在一定局限性;ORSSHF评分系统能较准确地评估该类患者的术前风险及预测术后并发症和死亡率,一定程度上弥补POSSUM评分系统的不足。     

POSSUM评分预测老年胃肠道肿瘤手术风险的临床意义

目的应用POSSUM评分对老年胃肠道肿瘤患者手术风险进行评估,以评价该评分的临床有效性,同时对多个手术风险的单因素进行分析,为临床治疗决策提供参考。方法对234例手术的老年胃肠道肿瘤患者进行POSSUM评分,同时统计术后实际并发症和死亡率,并与评分预测值进行比较,就有可能产生并发症和死亡的多个单因素进行比较分析。结果POSSUM评分预测并发症和死亡率分别为33.8%和6.8%,与实际并发症(26.1%)和死亡率(4.7%)较为接近;单因素比较分析显示5个单因素与并发症的产生有关联,2个单因素与患者死亡有关联。结论POSSUM评分系统可以较好地预测老年胃肠道肿瘤患者术后并发症和死亡率;5个手术风险的单因素应引起临床医师的高度重视。     

运用改良POSSUM评分系统预测颈椎手术并发症发生率

目的 探讨改良生理学和手术严重度评分系统(POSSUM)对预测颈椎手术患者术后并发症发生率的意义.方法 根据颈椎手术特点修改POSSUM评分系统中的部分指标(将手术严重度指标中的手术范围和手术次数替换为手术方式和手术持续时间.在生理学指标中增加颈椎核磁共振检查),并对183例颈椎手术患者术后并发症实际发生率和理论预测率进行比较.结果 按Copland公式理论预测有59例(32.2%)发生并发症,实际发生为52例(28.4%),二者比较,差异无显著性意义(P>0.05).结论 改良POSSUM评分系统能较准确地预测颈椎手术并发症发生率,对临床医疗护理工作有重要的指导意义.     

POSSUM评分系统预测高龄患者胰十二指肠切除术风险的价值

目的：探讨应用POSSUM评分系统评估高龄患者行胰十二指肠切除术（PD）风险的可靠性。方法：将2010年2月—2011年2月间收治的80例行PD患者按照年龄进行分为两组，其中38例≥80岁者为研究组，42例<80岁者作为对照组。分析两组术中、术后情况，比较两组POSSUM评分及POSSUM评分系统对两组并发症发生率与病死率的预测值与实际值间的差异。结果：研究组与对照组比较，手术时间、术中出血量、输血量均无统计学差异（P>0.05），但研究组的住院时间长于对照组（P<0.05）。研究组的POSSUM评分明显高于对照组的POSSUM评分（P<0.05）；研究组实际术后并发症发生率和病死率与预测值无统计学差异（P>0.05），而对照组的实际术后并发症发生率和病死率均低于预测值（P<0.05）。结论：采用POSSUM评分系统能够较准确评估高龄患者行PD的手术风险，故对患者围术期管理具有重要的指导意义。

     

POSSUM scoring for laparoscopic cholecystectomy in the elderly

BACKGROUND: Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) scoring is a validated scoring system in the audit of surgical outcomes; however, evaluation of this system has mostly been applied to open surgical techniques. The present study examines the validity of POSSUM in predicting morbidity and mortality in patients undergoing laparoscopic cholecystectomy (LC) with the recognized risk factor for postoperative mortality of advanced age. METHODS: All patients aged 80 years or over undergoing LC in one surgical unit between January 1993 and December 1999 were identified from the surgical operations database of the hospital. Case-note review was used to collate data in terms of clinical and operative factors as described in POSSUM. Observed/POSSUM estimated (O/E) ratio of morbidity and 30-day mortality were calculated. RESULTS: Laparoscopic cholecystectomy was performed in 76 patients aged 80 years or over during the study period. Of these patients, case notes for 70 patients (92%) were available for review. Median (range) age was 83 years (80-93 years) and median (range) American Society of Anesthesiologists score was 2 (2-4). Twenty-six (34%) of 70 patients underwent cholecystectomy during an acute admission. The mean physiology severity score was 23 and operative severity score, 8. A significant postoperative morbidity was observed in 15 (22%) of 70 patients. There was no 30-day mortality. Using exponential analysis, POSSUM predicted morbidity in 15 patients and mortality in seven patients. Thus, O/E ratios for morbidity and mortality were 1 and 0, respectively. CONCLUSION: POSSUM scoring performs well in predicting morbidity, but overpredicts mortality, after LC in patients aged over 80 years. An assessment of its application to other laparoscopic procedures merits evaluation.     

POSSUM scoring system as an instrument of audit in lung resection surgery. Physiological and operative severity score for the enumeration of mortality and morbidity

BACKGROUND: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system that was validated in general surgery with the aim of being used as an instrument to evaluate surgical outcome. We applied POSSUM to a population of lung resection candidates to assess its capability to predict postoperative complications. METHODS: Two hundred fifty lung resection candidates were prospectively evaluated from 1993 through 1996. The POSSUM value was entered along with other variables (sex, smoking history, type of resection, pulmonary function tests, arterial carbon dioxide, serum albumin level, total lymphocyte count, neoadjuvant chemotherapy and radiotherapy, and diabetes) in a multivariate analysis to identify independent predictors of postoperative morbidity. RESULTS: Logistic regression analysis showed POSSUM was predictive of postoperative complications, showing no significant difference between predicted and observed morbidity (chi2 test, p > 0.05). CONCLUSIONS: We think POSSUM can be appropriately used as a tool of surgical audit in lung resection operations.     

改良生理学和手术严重度评分系统预测骨盆髋臼骨折手术并发症发生概率的价值

目的 探讨改良生理学和手术严重度评分系统(POSSUM评分系统)预测骨盆髋臼骨折手术并发症发生概率的应用价值. 方法 回顾性分析1997年1月至2006年5月94例骨盆髋臼骨折患者术后住院期间并发症情况,我们按照骨科及骨盆髋臼骨折的特点对POSSUM评分系统进行改良:将手术严重度指标中以手术入路代替腹膜污染;将多种手术同时进行改为手术持续时间;将合并伤代替癌症;将手术大小和手术类型按照骨科手术特点进行4级制进行评分.应用POSSUM评分系统预测患者术后并发症发生概率,比较并发症组与无并发症组间各评分的差异.画出ROC曲线,描述符合程度,评价预测能力,确定截断点. 结果 并发症组38例,平均生理学评分17.26±2.84,平均手术严重度评分19.50±5.14,平均年龄(34.50±12.05)岁,伤后至手术时间(21.05±25.09)d;无并发症组56例,平均生理学评分16.04±2.77,平均手术严重度评分13.00±3.81,平均年龄(36.40±11.36)岁,伤后至手术时间(18.09±27.20)d.应用改良POSSUM评分系统评估:并发症组生理学评分、手术严重度评分均明显高于无并发症组,差异有统计学意义(P＜0.05);并发症组年龄、外伤至手术时间与无并发症组比较无差异均无统计学意义(P＞0.05).应用POSSUM评分系统预测并发症发生概率P=43%为截断点,灵敏度(SE)=73.68%,特异度(SP)=80.36%,符合率为77.66%,ROC曲线面积为0.856. 结论 改良POSSUM评分系统可用来准确预测骨盆髋臼骨折术后并发症发生概率,本评分系统可对患者术前的危重程度进行评价,当得分超过截断点时手术风险过大,不能耐受手术,需进行对症治疗或选择微创手术,待评分降至截断点范围内再行手术治疗,降低手术风险,确保手术安全.     

老年骨科患者围手术期风险评分的评价研究

目的 通过比较分析老年骨科患者围手术期风险评分( PRESGOP)与急性生理及慢性健康状况评分(APACHE)、计数死亡率和发病率的生理学和手术严重性评分(POSSUM)的有效性、相关性及预测的准确性,探讨PRESGOP评分在预测老年骨科患者术后并发症和死亡率方面的效能。方法 2009年1月至2010年2月,收集所有入骨科的65岁以上患者资料,按照PRESGOP、APACHE、POSSUM评分表分别计算评分结果。剔除未进行手术治疗的患者,再记录术后预后情况,共纳入401例患者。按照有无并发症、有无死亡分别分成2组,依次对PRESGOP、APACHE、POSSUM评分结果进行分析,另比较3种评分结果间的相关性以及预测术后并发症和死亡率ROC曲线的曲线下面积的差异。结果 有并发症组和无并发症组比较,3种评分结果差异均有统计学意义(P＜0.05)。死亡组和存活组比较,仅PRESGOP评分差异有统计学意义(P＜0.05)。3种评分间两两相关(P＜0.05)。PRESGOP、APACHE、POSSUM 3种评分总分与不良预后所得ROC曲线下面积分别为0.771、0.634、0.751,3种评分差异均有统计学意义(P＜0.05)。预测死亡率ROC曲线下面积分别为0.920、0.877、0.836,仅PRESGOP评分差异有统计学意义(P＜0.05)。结论 PRESGOP、APACHE、POSSUM 3种评分在老年骨科患者评价方面具有良好相关性,在预测骨科老年手术后并发症和死亡率方面同样有效,PRESGOP的效能相对更加准确。     

Outcome of elective primary surgery for diverticular disease of the sigmoid colon: a risk analysis based on the POSSUM scoring system

BACKGROUND: The outcome of surgery for diverticular disease of the sigmoid colon remains largely unclear. A comparison of studies is hardly possible because risk factors for diverticular disease severity and patient-related risk factors are lacking. The purpose of this study was to define morbidity and mortality of primary surgery for nonacute complications of diverticular disease of the sigmoid colon and to identify the risk factors that predict a higher morbidity and mortality. METHODS: Patients who underwent elective surgery for complications of diverticular disease of the sigmoid colon (n = 149) were identified in a prospective computerized morbidity and mortality registration. In all patients, the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) was calculated, as were the morbidity and mortality rates. Factors predicting postoperative morbidity and mortality were identified. To audit mortality figures, a POSSUM based scoring system is introduced. RESULTS: The mortality rate was 4.7% and morbidity rate was 53.7%. Significantly higher morbidity rates were correlated with a higher physiological POSSUM score (P = 0.010). Non-survivors were older (P = 0.029) and also had a higher physiological POSSUM score (P < 0.001) and operation severity POSSUM score (P < 0.001). CONCLUSION: The morbidity and mortality rates of surgery for nonacute complications of diverticular disease of the sigmoid colon are considerable. To a large extent, mortality and morbidity are driven by patient- and disease-related factors, as expressed by elevated physiological severity and operative severity scores and failures of peri-operative management in most deceased patients.     

Evaluation of POSSUM and P-POSSUM scoring systems in patients undergoing colorectal surgery

BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) equations were derived from a heterogeneous general surgical population and have been used successfully as audit tools to provide risk-adjusted operative mortality rates. Their applicability to high-risk emergency colorectal operations has not been established. METHODS: POSSUM variables were recorded for 1017 patients undergoing major elective (n = 804) or emergency (n = 213) colorectal surgery in ten hospitals. Subgroup analysis was performed to investigate the predictive capability of POSSUM and P-POSSUM in emergency and elective surgery and in patients in different age groups. RESULTS: The overall operative mortality rate was 7.5 per cent (POSSUM-estimated mortality rate 8.2 per cent; P-POSSUM-estimated mortality rate 7.1 per cent). In-hospital deaths increased exponentially with age. Both scoring systems overpredicted mortality in young patients and underpredicted mortality in the elderly (P < 0.001). Death was underpredicted by both systems for emergency cases, significantly so at a simulated emergency caseload of 47.9 per cent (P < 0.05). CONCLUSION: There is a lack of calibration of POSSUM and P-POSSUM systems at the extremes of age and high emergency workload. This has important implication in clinical practice, as consultants with a high emergency workload may seem to underperform when these scoring systems are applied. Recalibration or remodelling strategies may facilitate the application of POSSUM-based systems in colorectal surgery.