Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy.
Evaluation of POSSUM scoring system in patients with gastric cancer undergoing D2-gastrectomy.
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DOI：
10.1186/1471-2482-5-8
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发表时间：
2005-04-15
期刊：
影响因子：
1.9
通讯作者：
Holscher, Arnulf H
中科院分区：
文献类型：
--
作者：
Bollschweiler, Elfriede;Lubke, Thomas;Holscher, Arnulf H
背景：风险调整和分层在质量保证和临床研究中发挥着重要作用。POSSUM （Physiological and operation Severity Score for enUmeration of Mortality and morbidity）是一种基于12个患者特征和6个手术特征的患者风险预测模型。然而，由于POSSUM是为普通外科单位的质量评估而开发的，因此其在特定亚组中的表现仍需要评估。本研究的目的是评估POSSUM预测d2胃切除术后胃癌患者死亡率和发病率的准确性。方法：137例胃癌患者行胃切除术。前瞻性地进行详细、标准化的风险评估和术后病程的全面记录，然后计算POSSUM评分。结果：30天和90天死亡率分别为3.6% （n = 5）和5.8% （n = 8）。65.7% （n = 90）的患者术后过程正常，无重大并发症，14.6% （n = 20）有中度并发症，13.9% （n = 19）有严重并发症。POSSUM-Mortality Risk Score （R1）预测的死亡人数是中位和高危组实际死亡人数的两倍，是低危组实际死亡人数的8倍多（R1 < 20%）。然而，计算得到的R1对各风险组严重发病或术后死亡的预测效果较好：预测低危患者严重发病或术后死亡的实际发生率（AR）为14%，预测中危患者为23%，预测高危患者为50% （p < 0.05）。possum -发病风险评分（R2）高估了发病风险。结论：POSSUM评分可用于评价胃癌d2 -胃切除术患者的围手术期和术后病程。然而，这里检查的评分都不能用于术前预测术后病程。
BACKGROUND: Risk adjustment and stratification play an important role in quality assurance and in clinical research. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is a patient risk prediction model based on 12 patient characteristics and 6 characteristics of the surgery performed. However, because the POSSUM was developed for quality assessment in general surgical units, its performance within specific subgroups still requires evaluation. The aim of the present study was to assess the accuracy of POSSUM in predicting mortality and morbidity in patients with gastric cancer undergoing D2-gastrectomy.METHODS: 137 patients with gastric cancer undergoing gastrectomy were included in this study. Detailed, standardized risk assessments and thorough documentation of the post-operative courses were performed prospectively, and the POSSUM scores were then calculated.RESULTS: The 30- and 90-day mortality rates were 3.6% (n = 5) and 5.8% (n = 8), respectively. 65.7% (n = 90) of patients had normal postoperative courses without major complications, 14.6% (n = 20) had moderate and 13.9% (n = 19) had severe complications. The number of mortalities predicted by the POSSUM-Mortality Risk Score (R1) was double the actual number of mortalities occurring in the median and high-risk groups, and was more than eight times the actual number of mortalities occurring in the low-risk group (R1 < 20%). However, the calculated R1 predicted rather well in terms of severe morbidity or post-operative death in each risk group: in predicted low risk patients the actual occurrence rate (AR) of severe morbidity or post-operative death was 14%, for predicted medium risk patients the AR was 23%, and for predicted high risk patients the AR was 50% (p < 0.05). The POSSUM-Morbidity Risk Score (R2) overestimated the risk of morbidity.CONCLUSION: The POSSUM Score may be beneficial and can be used for assessment of the peri- and post-operative courses of patients with gastric carcinoma undergoing D2-gastrectomy. However, none of the scores examined here are useful for preoperative prediction of postoperative course.