The Surgical Apgar Score Predicts Postoperative ICU Admission
The Surgical Apgar Score Predicts Postoperative ICU Admission
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DOI：
10.1007/s11605-014-2733-8
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发表时间：
2015-03-01
影响因子：
3.2
通讯作者：
Melis, Marcovalerio
中科院分区：
文献类型：
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作者：
Glass, Nina E.;Pinna, Antonio;Melis, Marcovalerio
背景过去，已经开发了许多评分系统，其目标是预测围手术期结果，包括美国麻醉医师协会（阿萨）分级、用于死亡率和死亡率计数的生理学和手术严重度评分（POSSUM）、手术风险评分、生物化学和血液学结果模型、急性生理学和慢性健康评价（APACHE）、克利夫兰临床基金会结直肠癌模型、法国外科协会结直肠评分和国家外科质量改进计划（NSQIP）死亡率预测指标。1-5然而，大多数这些系统是复杂的，专有的，有限的（无论是术前风险或生理变量的单一测量），并往往难以在患者的日常护理中实施。例如，阿萨主要是虚弱指数，其简单且广为人知，但受到显著的用户间可变性的限制，因为其不依赖于客观标准，并且其在患者的手术过程期间不考虑患者的生理状况。2 POSSUM使用12个生理变量和6个术中变量来创建评分，由于过度预测低风险患者的风险，因此已在许多方面进行了修改，以尝试提高预测。APACHE及其最近的修改是一种复杂的专有评分系统，因此难以在床边使用。
BackgroundIn the past, many scoring systems have been developed with a goal of predicting perioperative outcomes, including American Society of Anesthesiologists (ASA) class, Physiologic and Operative Severity Score for the Enumeration [sic] of Mortality and Morbidity (POSSUM), Surgical Risk Score, Biochemistry and Haematology Outcome Models, Acute Physiology and Chronic Health Evaluation (APACHE), Cleveland Clinic Foundation Colorectal Cancer Model, the French Association of Surgery’s colorectal scale, and the National Surgical Quality Improvement Program (NSQIP) mortality predictor. 1–5 However, most of these systems are complicated, proprietary, limited (either to preoperative risk or to a single measurement of physiologic variables), and tend to be difficult to implement in the everyday care of patients. For example, the ASA is primarily a frailty index that is simple and widely known but is limited by significant inter-user variability since it does not depend on objective criteria and it does not factor in the patients physiologic condition during the course of their operation. 2 POSSUM uses 12 physiological variables and 6 intraoperative variables to create a score, and because of overprediction of risk in low-risk patients, it has been modified in many ways to try to improve prediction. APACHE and its more recent modifications is a complex and proprietary scoring system that is therefore difficult to use at the bedside.