Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy
Comparative analysis of APACHE-II and P-POSSUM scoring systems in predicting postoperative mortality in patients undergoing emergency laparotomy
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DOI：
10.12998/wjcc.v7.i16.2227
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发表时间：
2019-08-26
影响因子：
1.1
通讯作者：
Chugh, Parul
中科院分区：
文献类型：
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作者：
Nag, Deb Sanjay;Dembla, Ankur;Chugh, Parul
背景剖腹手术仍然是最常见的急诊外科手术之一。早期预后评估将有助于选择高危患者进行积极治疗。对风险的认识可能有助于提高围手术期护理的质量和资源的最佳利用。朴茨茅斯生理学和手术严重度计数死亡率和发病率的修正(P-POSSUM)和急性生理学和慢性健康评估II(APACHE-II)是急诊剖腹手术中应用最广泛的评分系统。目的比较APACHE-II和P-POSSUM对急诊剖腹手术患者术后发病率和死亡率的预测能力。方法：本研究纳入了2013年12月至2014年11月在贾姆谢德布尔塔塔主医院接受急诊剖腹手术的所有患者。本研究采用P-POSSUM和APACHE-II评分，以死亡率为主要结果进行预后分析。结果P-POSSUM以63为临界值，用受试者操作特征曲线分析预测死亡率，曲线下面积为0.989；APACHE-II以24为临界值，曲线下面积为0.965。结论由于APACHE-II预测死亡率的能力与P-POSSUM相似，并且APACHE-II不需要对术中发现和组织病理学报告进行评分，因此APACHE-II可用于术前评估急诊剖腹手术患者的风险。但是，出于审计目的，可以使用这两种评分系统中的任何一种。
BACKGROUNDLaparotomy remains one of the commonest emergency surgical procedures. Early prognostic evaluation would aid in selecting the high-risk patients for an aggressive treatment. Awareness about risks could potentially contribute to the quality of perioperative care and optimum utilization of resources. Portsmouth modification of Physiological and operative severity for the enumeration of mortality and morbidity (P-POSSUM) and the acute physiology and chronic health evaluation II (APACHE-II) have been the most widely used scoring systems for emergency laparotomies. It is always better to have a single scoring system to predict outcomes and audit healthcare organizations.AIMTo compare the ability of APACHE-II and P-POSSUM to predict postoperative morbidity and mortality in patients undergoing emergency laparotomy.METHODSAll patients undergoing emergency laparotomy at the Tata Main Hospital, Jamshedpur between December 2013 and November 2014 were included in the study. In this observational study, P-POSSUM and APACHE-II scoring were done, and the outcome analysis evaluated with mortality being the primary outcome.RESULTSFor P-POSSUM, at a cut off value of 63 to predict mortality using receiver operating characteristics curve analysis, the area under the curve was 0.989; and for APACHE-II, at the cut off value of 24, the area under the curve was 0.965.CONCLUSIONBecause the ability of APACHE-II to predict mortality was similar to P-POSSUM and APACHE-II does not need scoring for intra-operative findings and histopathology reports, APACHE-II can be used pre-operatively to assess the risk in patients undergoing emergency laparotomy. However, for audit purposes, either of the two scoring systems can be used.