Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems.
Prediction of Mortality in Patients After Oncologic Gastrointestinal Surgery: Comparison of the ASA, APACHE II, and POSSUM Scoring Systems.
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DOI：
10.7759/cureus.13684
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发表时间：
2021-03-04
期刊：
影响因子：
--
通讯作者：
Cevik BE
中科院分区：
文献类型：
--
作者：
Kisa NG;Kisa E;Cevik BE
已经开发了评分系统来预测外科手术中的预期死亡率和发病率。在这项研究中，我们的目的是比较阿萨（美国麻醉医师协会），APACHE（急性生理学和慢性健康评价）II，POSSUM（生理和手术严重程度评分的死亡率和发病率的enUmeration）评分系统作为死亡率的预测因素，在接受胃肠道肿瘤手术，随访，并在术后期间入住重症监护室的患者。我们检查了82例接受肿瘤胃肠手术并在重症监护室（ICU）随访的患者的档案。根据APACHE II、POSSUM和阿萨评分，患者的APACHE II评分和预测死亡率（PMR）为 计算了在评估阿萨、APACHE和POSSUM评分系统在准确评估死亡率方面的性能时，使用了受试者操作特征（ROC）曲线分析。因此，曲线下面积（AUC）= 0.5无区别，0.5 <AUC <0.7测试的区分能力在统计学上不显著，0.7 <AUC <0.8可接受，0.8 <AUC <0.9非常好，0.9 <AUC <1完美。评估显示，APACHE II的性能最好，为0.81，其次是POSSUM，其水平为0.78，可接受。另一方面，阿萨评分为0.63，其辨别力被确定为统计学上不显著。我们的研究结果表明，POSSUM和APACHE II评分系统在预测术后死亡率方面优于阿萨评分系统。POSSUM和APACHE II评分系统均可用于预测因肿瘤性胃肠道疾病接受手术的患者的死亡率。
Scoring systems have been developed to predict the expected mortality and morbidity in surgical procedures. In this study, our aim was to compare the ASA (American Society of Anesthesiologists), APACHE (Acute Physiology and Chronic Health Evaluation) II, POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) scoring systems as predictors of mortality in patients who underwent gastrointestinal oncologic surgery, followed, and were admitted to the intensive care unit during the postoperative period. We examined the files of 82 patients who underwent oncologic gastrointestinal surgery and followed up in the intensive care units (ICUs). The patients’ APACHE II scores and predicted mortality rates (PMR) according to the APACHE II, POSSUM, and ASA scores were calculated. The receiver operator characteristic (ROC) curve analysis was used when evaluating the performances of the ASA, APACHE, and POSSUM scoring systems in terms of accurate assessment of mortality. Accordingly, the area under the curve (AUC) = 0.5 no distinction, 0.5 <AUC <0.7 discriminative power of the test is statistically not significant, 0.7 <AUC <0.8 acceptable, 0.8 <AUC <0.9 very good and 0.9 <AUC <1 perfect. The evaluations showed that APACHE II had the best performance with 0.81, followed by POSSUM, which had an acceptable level at 0.78. On the other hand, the ASA score was 0.63 and its discriminative power was identified as statistically insignificant. Our results show that the POSSUM and APACHE II scoring systems were better at predicting mortality than the ASA scoring system for the prediction of mortality in the postoperative period. Both the POSSUM and APACHE II scoring systems can be confidently used for the prediction of mortality in patients undergoing operations due to oncologic gastrointestinal diseases.
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