Risk-adjusted surgical audit with the POSSUM scoring system in a developing country
Risk-adjusted surgical audit with the POSSUM scoring system in a developing country
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DOI：
10.1046/j.0007-1323.2001.01979.x
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发表时间：
2002-01-01
影响因子：
9.6
通讯作者：
Ng, KJ
中科院分区：
文献类型：
--
作者：
Yii, MK;Ng, KJ
背景资料：死亡率和发病率的生理和手术严重度评分（POSSUM）是一种客观和适当的评分系统，用于风险调整的比较普外科审计。该评分是在英国设计的，并已被广泛使用，但POSSUM在英国以外的中心的应用一直有限，特别是在发展中国家。这项前瞻性研究验证了它的应用程序在一个不同的人口和水平的resources.Methods：所有的普通外科手术的病人谁是在区域或全身麻醉下手术的住院病人超过4个月的时间在沙捞越总医院在1999年进入研究。所有数据（12个生理因素和6个手术因素）仅用POSSUM方程和改良的朴茨茅斯POSSUM（P-POSSUM）方程分析死亡率。预测和观察到的死亡率之间进行比较，根据四组的风险：0-4，5-14，15-49和50%或以上使用的“线性”的分析方法。约56.7%的患者属于风险最低的群体。POSSUM预测方程显著高估了该组的死亡率，其系数为9.3。观察到的总死亡率为6.1%，POSSUM预测方程再次高估了10.5%（P < 0.01）。相比之下，观察到的和预测的死亡率为所有风险组，包括预测的总死亡率为4.8%，是可比的P-POSSUM预测方程used.Conclusion：POSSUM评分系统与修改后的P-POSSUM预测方程的死亡率是适用于马来西亚，一个发展中国家，风险调整后的手术审计。该评分系统可以作为一个有用的比较审计工具，在许多地理位置的手术实践。
Background: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is an objective and appropriate scoring system for risk-adjusted comparative general surgical audit. This score was devised in the UK and has been used widely, but application of POSSUM to centres outside the UK has been limited, especially in developing countries. This prospective study validated its application in a surgical practice with a different population and level of resources.Methods: All general surgical patients who were operated on under regional or general anaesthesia as inpatients over a 4-month period at Sarawak General Hospital in 1999 were entered into the study. All data (12 physiological and six operative factors) were analysed for mortality only with the POSSUM equation and the modified Portsmouth POSSUM (P-POSSUM) equation. Comparisons were made between predicted and observed mortality rates according to four groups of risk: 0-4, 5-14, 15-49 and 50 per cent or more using the 'linear' method of analysis.Results: There were 605 patients who satisfied the criteria for the study. Some 56.7 per cent of patients were in the lowest risk group. The POSSUM predictor equation significantly overestimated the mortality in this group, by a factor of 9.3. The overall observed mortality rate was 6.1 per cent and, again, the POSSUM predictor equation overestimated it at 10.5 per cent (P < 0.01). In contrast, the observed and predicted mortality rates for all risk groups, including the predicted overall mortality rate of 4.8 per cent, were comparable when the P-POSSUM predictor equation was used.Conclusion: The POSSUM scoring system with the modified P-POSSUM predictor equation for mortality was applicable in Malaysia, a developing country, for risk-adjusted surgical audit. This scoring system may serve as a useful comparative audit tool for surgical practice in many geographical locations.