Validation of POSSUM, P-POSSUM and the surgical risk scale in major general surgical operations in Harare: A prospective observational study
Validation of POSSUM, P-POSSUM and the surgical risk scale in major general surgical operations in Harare: A prospective observational study
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DOI：
10.1016/j.amsu.2019.03.007
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发表时间：
2019-05-01
影响因子：
1.7
通讯作者：
Muguti, Edwin G.
中科院分区：
文献类型：
--
作者：
Ngulube, Allan;Muguti, Godfrey I.;Muguti, Edwin G.
背景：原始死亡率和发病率，虽然在外科审计中被普遍研究，但由于患者术前和术中发现的不同，仍然可能具有误导性。有一些专门为病例组合而设计的常见评分系统，但这些系统尚未在当地试用。本研究旨在验证这些评分系统，并有望将其应用于我们的教学医院。材料和方法：在哈拉雷的两家中心医院进行了一项前瞻性观察队列研究，202名接受各种大手术的患者进入研究。根据POSSUM、P-POSSUM和SRS评分对患者的生理参数和术中参数进行评分。结果：181例患者中，男性12 3例，女性5 8例。使用POSSUM发病率评分，观察值与期望值(O：E)之比为0.88，无差异(p=0.970)。采用POSSUM、P-POSSUM和SRS死亡率评分，O/E值分别为0.74、1.06和1.0，差异无统计学意义(p=0.650、p=0.987和0.730)。三种评分在受试者操作特征曲线上具有可比性。生理评分独立预测死亡率(P<；0.00001)。结论：POSSUM、P-POSSUM和SRS评分具有可比性，适用于评估哈拉雷大手术后的预后。需要一项包括低风险患者在内的更大规模的研究，以将这些发现推广到津巴布韦患者。
Background: Raw mortality and morbidity, though commonly studied in surgical audit can nonetheless be misleading because of differences in preoperative and intraoperative findings of patients. There are some common scoring systems specifically designed to cater for case mix but these have not been tried locally. This study sought to validate these scoring systems and hopefully adopt them for our teaching hospitals.Materials and methods: A prospective observational cohort study was conducted at two central hospitals in Harare Two hundred and two patients undergoing a variety of major general surgical operations were recruited into the study. Results of physiological and intraoperative parameters collected from the patients' records were scored according to POSSUM, P-POSSUM and SRS scores. Predicted mortality and morbidity rates of all these subjects were then compared to the observed rates.Results: One hundred and eighty one patients participated (123 males, 58 females). Using the POSSUM morbidity score, the observed versus expected (O:E) ratio of 0.88 showed no difference (p = 0.970). Using POSSUM, P-POSSUM and SRS mortality scores, O: E ratios of 0.74, 1.06 and 1.0 respectively were obtained, the differences were not significant (p = 0.650, p = 0.987 and 0.730). All three scores were comparable on the Receiver Operating Characteristic curve. The Physiological score independently predicted mortality (p < 0.00001).Conclusion: POSSUM, P-POSSUM and SRS scores are comparable and suitable for estimating outcomes after major surgery in Harare. A larger study inclusive of low risk patients is needed to generalise these findings across Zimbabwean patients.