POSSUM and P-POSSUM as Predictors of Postoperative Morbidity and Mortality in Patients Undergoing Hepato-biliary-pancreatic Surgery: A Meta-analysis
POSSUM and P-POSSUM as Predictors of Postoperative Morbidity and Mortality in Patients Undergoing Hepato-biliary-pancreatic Surgery: A Meta-analysis
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DOI：
10.1245/s10434-013-2893-x
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发表时间：
2013-08-01
影响因子：
3.7
通讯作者：
Wang, Jian
中科院分区：
文献类型：
--
作者：
Chen, Tao;Wang, Haolu;Wang, Jian
死亡率和发病率计数的生理和手术严重程度评分 (POSSUM) 模型广泛用于预测普通外科的术后发病率和死亡率。目的是对这些模型对接受肝胆胰手术的患者的预测价值进行首次荟萃分析。通过搜索 1991 年至 2012 年的电子数据库来确定符合条件的文章。所有数据均特定于肝胆胰手术。通过计算加权观察值与预期值 (O/E) 比率来评估发病率和死亡率的预测价值。还进行了亚组分析。最终审查中纳入了十六项研究。发病率分析包括九项关于 POSSUM 的研究，加权 O/E 比为 0.78 [95% 置信区间 (CI) 0.68-0.88]。死亡率分析包括七项 POSSUM 研究和九项 P-POSSUM（朴茨茅斯死亡率预测方程）研究。 POSSUM 的死亡率加权 O/E 比为 0.35 (95% CI 0.17-0.54)，P-POSSUM 的加权 O/E 比为 0.95 (95% CI 0.65-1.25)。在大样本量研究（O/E 比 0.90；95% CI 0.85-0.96）中，与小样本研究相比，在大样本量研究（O/E 比 0.90；95% CI 0.85-0.96）中，POSSUM 预测胰腺手术后发病率（O/E 比 0.82；95% CI 0.72-0.92）比肝胆手术后（O/E 比 0.66；95% CI 0.57-0.74）更准确。规模研究（O/E 比 0.69；95% CI 0.59-0.79）。POSSUM 高估了肝胆胰手术后的术后发病率。 POSSUM 对发病率的预测价值受到手术类型和研究样本量的影响。与 POSSUM 相比，P-POSSUM 预测术后死亡率更为准确。肝胆胰手术的审核需要对 POSSUM 和 P-POSSUM 进行修改。
Physiologic and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) models are used extensively to predict postoperative morbidity and mortality in general surgery. The aim was to undertake the first meta-analysis of the predictive value of these models in patients undergoing hepato-biliary-pancreatic surgery.Eligible articles were identified by searches of electronic databases from 1991 to 2012. All data were specific to hepato-biliary-pancreatic surgery. Predictive value of morbidity and mortality were assessed by calculating weighted observed to expected (O/E) ratios. Subanalysis was also performed.Sixteen studies were included in final review. The morbidity analysis included nine studies on POSSUM with a weighted O/E ratio of 0.78 [95 % confidence interval (CI) 0.68-0.88]. The mortality analysis included seven studies on POSSUM and nine studies on P-POSSUM (Portsmouth predictor equation for mortality). Weighted O/E ratios for mortality were 0.35 (95 % CI 0.17-0.54) for POSSUM and 0.95 (95 % CI 0.65-1.25) for P-POSSUM. POSSUM had more accuracy to predict morbidity after pancreatic surgery (O/E ratio 0.82; 95 % CI 0.72-0.92) than after hepatobiliary surgery (O/E ratio 0.66; 95 % CI 0.57-0.74), in large sample size studies (O/E ratio 0.90; 95 % CI 0.85-0.96) than in small sample size studies (O/E ratio 0.69; 95 % CI 0.59-0.79).POSSUM overpredicted postoperative morbidity after hepato-biliary-pancreatic surgery. Predictive value of POSSUM to morbidity was affected by the type of surgery and the sample size of studies. Compared with POSSUM, P-POSSUM was more accurate for predicting postoperative mortality. Modifications to POSSUM and P-POSSUM are needed for audit in hepato-biliary-pancreatic surgery.