Validation of the CR-POSSUM risk-adjusted scoring system for major colorectal cancer surgery in a single center
Validation of the CR-POSSUM risk-adjusted scoring system for major colorectal cancer surgery in a single center
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DOI：
10.1007/s10350-006-797-6
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发表时间：
2007-02-01
影响因子：
3.9
通讯作者：
Cunliffe, William J.
中科院分区：
文献类型：
--
作者：
Bromage, Stephen J.;Cunliffe, William J.
目得：预测手术死亡率的评分系统是用于向操作者和患者提供信息以及审核临床实践的重要工具。本研究旨在在单中心结直肠癌手术中验证最近开发的结直肠生理和手术严重程度评分（CR-POSSUM）评分系统的死亡率和死亡率计数。我们还分析了白蛋白是否可能在CR-POSSUM模型中发挥作用。方法：我们将该模型与其他两种评分系统：POSSUM和Portsmouth-POSSUM（P-POSSUM）模型进行了比较。住院死亡率作为结果，Hosmer-Lemeshow统计量用于确定拟合优度。结果：从1990年至今，前瞻性收集了304例患者的完整数据。手术死亡率为6.5%。在给定的预测死亡率下，使用观察值与预期值的比值来比较评分系统。CR-POSSUM的总体观察值与预期值之比为1.25，P-POSSUM为1.59，POSSUM为3.37。CR-POSSUM模型显示与数据拟合良好（Hosmer-Lemeshow统计量，3.86; P = 0.795），受试者操作曲线下面积为0.74。校正CR-POSSUM中使用的因素后，logistic回归显示白蛋白与死亡率之间存在显著相关性（P=0.016）。结论：我们已经证明，CR-POSSUM模型是一个准确的预测结直肠大手术的结果。POSSUM和P-POSSUM模型高估了死亡率。白蛋白，这是不包括在这三个系统中的一个因素，可能是一个重要的补充，提高CR-POSSUM模型的准确性。
PURPOSE: Scoring systems to predict mortality from surgery are important tools used to give information to the operator and patient and in the auditing of clinical practice. This study was designed to validate the recently developed the Colorectal Physiologic and Operative Severity Score for the Enumeration of Mortality and Morbidity (CR-POSSUM) scoring system in a single center for colorectal cancer surgery. We also analyzed whether albumin may have a role in the CR-POSSUM model. METHODS: We compared this model with two other scoring systems: POSSUM and Portsmouth-POSSUM (P-POSSUM) models. Inhospital mortality was used as the outcome, and Hosmer-Lemeshow statistic was used to determine goodness of fit. RESULTS: Complete data were collected prospectively from 304 patients from 1990 to the present. The overall operative mortality was 6.5 percent. Observed to expected ratios were used to compare the scoring systems at a given predicted mortality. The overall observed to expected ratio was 1.25 for CR-POSSUM, 1.59 for P-POSSUM, and 3.37 for POSSUM. The CR-POSSUM model showed a good fit with the data (Hosmer-Lemeshow statistic, 3.86; P = 0.795) and the area under the receiver operator curve was 0.74. After correcting for factors used in the CR-POSSUM, logistic regression showed a significant correlation between albumin and mortality (P=0.016). CONCLUSIONS: We have shown that the CR-POSSUM model is an accurate predictor of outcome for major colorectal surgery. The POSSUM and P-POSSUM models over-predicted mortality. Albumin, which is not a factor included in these three systems, may be an important addition in improving the accuracy of the CR-POSSUM model.