Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK
Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK
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DOI：
10.1002/bjs.4347
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发表时间：
2003-12-01
影响因子：
9.6
通讯作者：
Parides, MK
中科院分区：
文献类型：
--
作者：
Bennett-Guerrero, E;Hyam, JA;Parides, MK
背景资料：在英国，死亡率和发病率的生理和手术严重度评分（POSSUM）标准已用于评估患者的手术风险。目的是确定这些标准是如何适用于接受手术的患者在美国。方法：两个队列的患者接受重大非心脏手术进行了前瞻性随访，在美国（n = 1056）和英国（n = 1539）。使用已建立的POSSUM标准，为每位患者分配术前生理状态和手术严重程度的风险评分。住院死亡是主要的结局指标。对于每例患者，使用已建立的方程，根据朴茨茅斯POSSUM（P-POSSUM）方法计算预测的死亡风险。结果：在每个队列中，P-POSSUM估计的危险性增加预测观察死亡率增加（P < 0.001）。然而，对于任何给定的风险水平，英国队列的死亡率显著高于美国队列（比值比4.50（95%置信区间2.81至7.19）; Z = 6.25，P < 0.001）。结论：基于P-POSSUM方法，预测风险的增加与两国患者的较高死亡率相关。然而，在英国队列中，大手术后的风险调整死亡率高出四倍。这些显著差异需要在更多的中心进行验证。
Background: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) criteria have been used to assess surgical risk in patients in the UK. The aim was to determine how applicable these criteria are to patients undergoing surgery in the USA.Methods: Two cohorts of patients undergoing major non-cardiac surgery were followed prospectively in the USA (n = 1056) and the UK (n = 1539). Each patient was assigned a risk score for preoperative physiological status and operative severity using the established POSSUM criteria. Death in hospital was the primary outcome measure. For each patient a predicted risk of death was calculated from Portsmouth POSSUM (P-POSSUM) methodology using an established equation. The relationships between predicted and observed mortality rates in each cohort were investigated by means of multivariate logistic regression.Results: Within each cohort, an increase in risk estimated by P-POSSUM predicted an increase in observed mortality rate (P < 0.001). For any given risk level, however, mortality rates were significantly higher in the UK cohort than in the US cohort (odds ratio 4.50 (95 per cent confidence interval 2.81 to 7.19); Z = 6.25, P < 0.001).Conclusion: An increase in predicted risk, based on the P-POSSUM methodology, was associated with a higher mortatity rate in patients from both countries. However, risk-adjusted mortality rates following major surgery were four times higher in the UK cohort. These marked differences warrant validation in a larger number of centres.