目的:通过利用POSSUM、P-POSSUM和APACHE-Ⅱ评分对我院行手术治疗的肝门部胆管癌病例的术后住院死亡率的预测进行预测,评价各评分的预测能力,为肝门部胆管癌术后死亡风险寻求有效的评估方法。方法:收集了2002年1月～2007年12月期间在东...目的:通过利用POSSUM、P-POSSUM和APACHE-Ⅱ评分对我院行手术治疗的肝门部胆管癌病例的术后住院死亡率的预测进行预测,评价各评分的预测能力,为肝门部胆管癌术后死亡风险寻求有效的评估方法。方法:收集了2002年1月～2007年12月期间在东方肝胆外科医院接受手术治疗的348例肝门部胆管癌的病例资料,统计其手术后的住院死亡率;统计学方法:所有的数据通过SPSS15.0 for windows、Medcalc9.2.10 for windows进行分析处理,计量资料经t检验、计数资料以x2检验和Z检验,P<0.05为有统计学意义;O:E值和ROC曲线用来评价评分方法的判别能力。结果:348例患者的术后有6例发生住院期间死亡,死亡率为1.7%,POSSUM评分预测的住院死亡率为9.3%(33例),两者之间的差异有统计学意义(x2=19.80,df=1,P<0.01);P-POSSUM评分预测的住院死亡率2.8%(10例),两者之间的差异无统计学意义(x2=1.02,df=1,P>0.05);APACHE-Ⅱ评分预测的住院死亡率9.2%(32例),两者之间的差异有统计学意义(x2=18.82,df=1,P<0.01)。POSSUM、P-POSSUM和APACHE-Ⅱ评分对应的ROC曲线下面积分别为0.759、0741和0.608。结论:P-POSSUM评分能很好的预测肝门部胆管癌手术的术后住院死亡率,POSSUM和APACHE-Ⅱ评分不能准确的预测,明显高估了术后死亡风险。展开更多
目的分析目前POSSUM和P-POSSUM这两种广泛用于普外科手术风险预测的评分系统对肝胆手术患者术后并发症发生率和死亡率的预测价值。方法计算机检索PubMed、h e Cochrane Library(2013年第10期))、Science Citation Index、CNKI、WanFang ...目的分析目前POSSUM和P-POSSUM这两种广泛用于普外科手术风险预测的评分系统对肝胆手术患者术后并发症发生率和死亡率的预测价值。方法计算机检索PubMed、h e Cochrane Library(2013年第10期))、Science Citation Index、CNKI、WanFang Data和CBM数据库,查找关于在肝胆手术中使用POSSUM和/或P-POSSUM评分系统预测术后并发症发生率和死亡率的研究,检索时限均为从1991年至2013年10月。由2位评价员根据纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Comprehensive Meta Analysis Version 2软件进行Meta分析。结果共纳入10个研究。其中:5个研究(n=683)采用POSSUM预测了术后并发症发生率,其加权O/E=0.71,95%CI(0.60,0.81);7个研究(n=1?291)采用POSSUM预测了术后死亡率,其加权O/E=0.42,95%CI(0.27,0.57);6个研究(n=1?793)采用P-POSSUM预测了术后死亡率,其加权O/E=0.74,95%CI(0.53,0.95)。结论 POSSUM可能会高估肝胆手术患者的术后并发症发生率,而P-POSSUM对肝胆手术患者术后死亡率预测的准确性明显高于POSSUM。展开更多
Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system previously validated in vascular and general surgical patients. The Portsmouth phy...Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system previously validated in vascular and general surgical patients. The Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) is a reliable tool derived from POSSUM to improve the prediction of mortality. In this paper, we utilized both models to determine the most suitable and feasible one that could be utilized in orthopedic surgery in China mainland. Methods: In this retrospective study, patients’ files were extracted randomly from the medical records department of the First Hospital Affiliated with Dalian Medical University for those underwent hip replacements between 1999 and 2006. The mortality and morbidity rates were predicted by P-POSSUM and POSSUM, respectively. A comparative analysis was performed between the observed and the predicted values as well as the Observed/Expected ratio (O:E). Results: A total of 206 patients were selected for this study after fulfilling the inclusion and exclusion criteria. The predicted mortality by P-POSSUM were not significantly different from the observed values (X2 = 2.10, P = 0.552). POSSUM appeared to be better with the observed morbidity (X2 = 2.766, P = 0.598), but had overestimated mortality. Conclusion: The POSSUM morbidity equation satisfactorily estimated the risk of postoperative complications, and the P-POSSUM mortality equation appeared to stratify the risk of death more accurate than the POSSUM.展开更多
PURPOSE: The Physiologic and Operative Severity Score for the enUmeration of M ortality and morbidity (POSSUM), Portsmouth revision (p)-POSSUM, and colorectal (Cr)-POSSUM scoring systems were developed as audit tools ...PURPOSE: The Physiologic and Operative Severity Score for the enUmeration of M ortality and morbidity (POSSUM), Portsmouth revision (p)-POSSUM, and colorectal (Cr)-POSSUM scoring systems were developed as audit tools for comparing outcomes in surgical and colorectal patients on the basis of operati ve risk assessment. The aim of this study was to evaluate the applicability of t hese systems to a cohort of colon cancer patients undergoing surgery in the Unit ed States. METHODS: POSSUM factors from 890 consecutive patients undergoing majo r surgical procedures for colon cancer in nine United States hospitals over a tw o-year period from January 2000 through December 2001 were prospectively collec ted. The observed over the expected hospital mortality was compared by means of the POSSUM, p-POSSUM, and Cr-POSSUM scoring systems. The effect of missing dat a on the utility of this process for outcome assessment was assessed with three methods for data imputation. RESULTS: The number of resections per institution r anged from 13 to 437. The observed mortality rate ranged from 0.8 percent to 15. 4 percent among the institutions, with an overall operative mortality of 2.3 per cent. The POSSUM, p-POSSUM, and Cr-POSSUM predicted mortality was 10.7 percent , 11.2 percent, and 4.9 percent, respectively. The POSSUM and p-POSSUM models o verpredicted mortality in all institutions (P < 0.01), whereas the Cr-POSSUM de monstrated an observed over expected hospital mortality ratio of >1 in three ins titutions. The calculations were unaffected by the various methods of inserting missing data. CONCLUSION: An apparent overprediction of mortality for colon canc er resection was evident with all three POSSUM variants. This implies that a cal ibration process is required for use of these variants in the United States heal th care system. Missing data may be treated as normal values without influencing outcome. The Cr-POSSUM appeared to be the most promising audit tool for colore ctal cancer surgery; however, it will require further refinement to provide proc ess control graphs for identification of potential outliers and improvement in t he quality of care in the United States.展开更多
目的 利用骨科死亡率和并发症发生率的生理学和手术严重度（physiological and operative severity score for the enumeration of mortality and morbidity,POSSUM）评分及改良POSSUM（Portsmouth modified POSSUM,P-POSSUM）评分系统...目的 利用骨科死亡率和并发症发生率的生理学和手术严重度（physiological and operative severity score for the enumeration of mortality and morbidity,POSSUM）评分及改良POSSUM（Portsmouth modified POSSUM,P-POSSUM）评分系统分别对老年髋部骨折术后并发症发生率和死亡率进行评估,探讨其在手术风险评估中的价值. 方法 应用POSSUM和P-POSSUM评分系统预测164例老年髋部骨折术后并发症发生率和死亡率.从实际值与预测值的比值、鉴别能力、拟合优度三方面评价其预测价值,其中鉴别能力和拟合优度分别通过受试者工作特征曲线（receiver operation characteristic curve,ROC）和Hosmer-Lemeshow检验评价. 结果 POSSUM评分系统预测老年髋部骨折术后并发症发生率：整体实际值/预测值为0.86,ROC曲线下面积为0.82,拟合优度检验良好（H2=3.66,df=8,P＞0.05）;P-POSSUM评分系统预测术后死亡率：整体实际值/预测值为0.80,ROC曲线下面积为0.93,拟合优度检验良好（H2=3.21,df=4,P＞0.05）,但POSSUM评分系统高估了死亡率（整体实际值/预值值为0.27）. 结论 POSSUM和P-POSSUM评分系统分别对老年髋部骨折术后并发症发生率和死亡率有良好的预测能力,但骨科POSSUM评分系统过高地估计了术后死亡率.展开更多
文摘目的:通过利用POSSUM、P-POSSUM和APACHE-Ⅱ评分对我院行手术治疗的肝门部胆管癌病例的术后住院死亡率的预测进行预测,评价各评分的预测能力,为肝门部胆管癌术后死亡风险寻求有效的评估方法。方法:收集了2002年1月～2007年12月期间在东方肝胆外科医院接受手术治疗的348例肝门部胆管癌的病例资料,统计其手术后的住院死亡率;统计学方法:所有的数据通过SPSS15.0 for windows、Medcalc9.2.10 for windows进行分析处理,计量资料经t检验、计数资料以x2检验和Z检验,P<0.05为有统计学意义;O:E值和ROC曲线用来评价评分方法的判别能力。结果:348例患者的术后有6例发生住院期间死亡,死亡率为1.7%,POSSUM评分预测的住院死亡率为9.3%(33例),两者之间的差异有统计学意义(x2=19.80,df=1,P<0.01);P-POSSUM评分预测的住院死亡率2.8%(10例),两者之间的差异无统计学意义(x2=1.02,df=1,P>0.05);APACHE-Ⅱ评分预测的住院死亡率9.2%(32例),两者之间的差异有统计学意义(x2=18.82,df=1,P<0.01)。POSSUM、P-POSSUM和APACHE-Ⅱ评分对应的ROC曲线下面积分别为0.759、0741和0.608。结论:P-POSSUM评分能很好的预测肝门部胆管癌手术的术后住院死亡率,POSSUM和APACHE-Ⅱ评分不能准确的预测,明显高估了术后死亡风险。
文摘目的分析目前POSSUM和P-POSSUM这两种广泛用于普外科手术风险预测的评分系统对肝胆手术患者术后并发症发生率和死亡率的预测价值。方法计算机检索PubMed、h e Cochrane Library(2013年第10期))、Science Citation Index、CNKI、WanFang Data和CBM数据库,查找关于在肝胆手术中使用POSSUM和/或P-POSSUM评分系统预测术后并发症发生率和死亡率的研究,检索时限均为从1991年至2013年10月。由2位评价员根据纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用Comprehensive Meta Analysis Version 2软件进行Meta分析。结果共纳入10个研究。其中:5个研究(n=683)采用POSSUM预测了术后并发症发生率,其加权O/E=0.71,95%CI(0.60,0.81);7个研究(n=1?291)采用POSSUM预测了术后死亡率,其加权O/E=0.42,95%CI(0.27,0.57);6个研究(n=1?793)采用P-POSSUM预测了术后死亡率,其加权O/E=0.74,95%CI(0.53,0.95)。结论 POSSUM可能会高估肝胆手术患者的术后并发症发生率,而P-POSSUM对肝胆手术患者术后死亡率预测的准确性明显高于POSSUM。
文摘Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system previously validated in vascular and general surgical patients. The Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) is a reliable tool derived from POSSUM to improve the prediction of mortality. In this paper, we utilized both models to determine the most suitable and feasible one that could be utilized in orthopedic surgery in China mainland. Methods: In this retrospective study, patients’ files were extracted randomly from the medical records department of the First Hospital Affiliated with Dalian Medical University for those underwent hip replacements between 1999 and 2006. The mortality and morbidity rates were predicted by P-POSSUM and POSSUM, respectively. A comparative analysis was performed between the observed and the predicted values as well as the Observed/Expected ratio (O:E). Results: A total of 206 patients were selected for this study after fulfilling the inclusion and exclusion criteria. The predicted mortality by P-POSSUM were not significantly different from the observed values (X2 = 2.10, P = 0.552). POSSUM appeared to be better with the observed morbidity (X2 = 2.766, P = 0.598), but had overestimated mortality. Conclusion: The POSSUM morbidity equation satisfactorily estimated the risk of postoperative complications, and the P-POSSUM mortality equation appeared to stratify the risk of death more accurate than the POSSUM.
文摘PURPOSE: The Physiologic and Operative Severity Score for the enUmeration of M ortality and morbidity (POSSUM), Portsmouth revision (p)-POSSUM, and colorectal (Cr)-POSSUM scoring systems were developed as audit tools for comparing outcomes in surgical and colorectal patients on the basis of operati ve risk assessment. The aim of this study was to evaluate the applicability of t hese systems to a cohort of colon cancer patients undergoing surgery in the Unit ed States. METHODS: POSSUM factors from 890 consecutive patients undergoing majo r surgical procedures for colon cancer in nine United States hospitals over a tw o-year period from January 2000 through December 2001 were prospectively collec ted. The observed over the expected hospital mortality was compared by means of the POSSUM, p-POSSUM, and Cr-POSSUM scoring systems. The effect of missing dat a on the utility of this process for outcome assessment was assessed with three methods for data imputation. RESULTS: The number of resections per institution r anged from 13 to 437. The observed mortality rate ranged from 0.8 percent to 15. 4 percent among the institutions, with an overall operative mortality of 2.3 per cent. The POSSUM, p-POSSUM, and Cr-POSSUM predicted mortality was 10.7 percent , 11.2 percent, and 4.9 percent, respectively. The POSSUM and p-POSSUM models o verpredicted mortality in all institutions (P < 0.01), whereas the Cr-POSSUM de monstrated an observed over expected hospital mortality ratio of >1 in three ins titutions. The calculations were unaffected by the various methods of inserting missing data. CONCLUSION: An apparent overprediction of mortality for colon canc er resection was evident with all three POSSUM variants. This implies that a cal ibration process is required for use of these variants in the United States heal th care system. Missing data may be treated as normal values without influencing outcome. The Cr-POSSUM appeared to be the most promising audit tool for colore ctal cancer surgery; however, it will require further refinement to provide proc ess control graphs for identification of potential outliers and improvement in t he quality of care in the United States.
文摘目的 利用骨科死亡率和并发症发生率的生理学和手术严重度（physiological and operative severity score for the enumeration of mortality and morbidity,POSSUM）评分及改良POSSUM（Portsmouth modified POSSUM,P-POSSUM）评分系统分别对老年髋部骨折术后并发症发生率和死亡率进行评估,探讨其在手术风险评估中的价值. 方法 应用POSSUM和P-POSSUM评分系统预测164例老年髋部骨折术后并发症发生率和死亡率.从实际值与预测值的比值、鉴别能力、拟合优度三方面评价其预测价值,其中鉴别能力和拟合优度分别通过受试者工作特征曲线（receiver operation characteristic curve,ROC）和Hosmer-Lemeshow检验评价. 结果 POSSUM评分系统预测老年髋部骨折术后并发症发生率：整体实际值/预测值为0.86,ROC曲线下面积为0.82,拟合优度检验良好（H2=3.66,df=8,P＞0.05）;P-POSSUM评分系统预测术后死亡率：整体实际值/预测值为0.80,ROC曲线下面积为0.93,拟合优度检验良好（H2=3.21,df=4,P＞0.05）,但POSSUM评分系统高估了死亡率（整体实际值/预值值为0.27）. 结论 POSSUM和P-POSSUM评分系统分别对老年髋部骨折术后并发症发生率和死亡率有良好的预测能力,但骨科POSSUM评分系统过高地估计了术后死亡率.
