E-PASS和POSSUM系统在评估老年腰椎骨折术后并发症的可行性分析

Feasibility analysis of the E-PASS system and POSSUM system in evaluating postoperative complications of lumbar fractures in the elderly

目的分析生理能力与手术应激评估(estimation of physiologic ability and surgical stress,E-PASS)系统、计数病死率和患病率的生理学和手术严重性评分(physiological and operative severity score for enumeration of mortality and morbidity,POSSUM)系统预测老年腰椎骨折术后并发症的可行性。方法选取我院2017年12月至2021年5月行腰椎椎弓根螺钉内固定治疗的268例老年腰椎骨折患者。根据患者住院期间临床病历信息及血液检查结果计算E-PASS系统和POSSUM系统分值,在术后1个月内统计并发症发生情况。研究两系统关系与术后并发症关系。结果(1)268例老年腰椎骨折患者中,75例(28.0%)出现术后并发症。主要术后并发症31例,次要术后并发症44例。(2)术后并发症组患者E-PASS系统[术前风险评分(preoperative risk score,PRS)、手术应激评分(surgical stress score,SSS)、综合风险评分(comprehensive risk score,CRS)]及POSSUM系统[生理学评分(physiological score,PS)、手术严重度评分(operative severity score,OSS)、总分]分值高于无术后并发症组患者(P<0.05)。术后并发症的ROC结果显示,E-PASS系统中的PRS、SSS、CRS AUC分别为0.659、0.649、0.778,POSSUM系统中的PS、OSS、总分AUC分别为0.655、0.665、0.732。(3)术后主要并发症组患者E-PASS系统(PRS、SSS、CRS)及POSSUM系统(PS、OSS、总分)分值高于无主要并发症组患者(P<0.05)。术后主要并发症ROC结果显示,E-PASS系统中的PRS、SSS、CRS AUC分别为0.734、0.695、0.834;POSSUM系统中的PS、OSS、总分分别为0.666、0.651、0.735。结论较POSSUM系统,E-PASS系统评估老年腰椎骨折手术治疗患者术后并发症具有更高临床应用价值及可行性,值得推广应用。

Objective To analyze the estimation of physiologic ability and surgical stress(E-PASS)system and physiological and operative severity score for enumeration of mortality and morbidity(POSSUM)system to predict postoperative complications of lumbar fractures in the elderly.Methods A total of 268 elderly patients with lumbar fractures were selected.All underwent lumbar pedicle screw internal fixation in our hospital from December 2017 to May 2021.We calculated the scores of the E-PASS system and POSSUM system according to the clinical medical record and blood examination results during hospitalization.Incidence of complication was counted within 1 month after operation.The relationship between the two systems and postoperative complications were studied.Results(1)Among 268 elderly patients with lumbar fractures,75 cases(28.0%)had postoperative complications.Main postoperative complications were observed in 31 cases,while secondary postoperative complications in 44 cases.(2)The scores of the E-PASS system[preoperative risk score(PRS),surgical stress score(SSS),comprehensive risk score(CRS)]and POSSUM system[physiological score(PS),operative severity score(OSS),total score]in the postoperative complication group were higher than those in the postoperative non-complication group(P<0.05).The ROC results of postoperative complications showed that PRS,SSS and CRS AUC in the E-PASS system were 0.659,0.649,0.778,respectively;PS,OSS and total score in the POSSUM system were 0.655,0.665,0.732,respectively.(3)The scores of the E-PASS system(PRS,SSS,CRS)and the POSSUM system(PS,OSS,total score)of the main complication group were higher than those of the non-main complication group(P<0.05).The ROC results of the main postoperative complications showed that PRS,SSS,and CRS AUC in the E-PASS system were 0.734,0.695,0.834,respectively;PS,OSS and total score in the POSSUM system were 0.666,0.651,0.735,respectively.Conclusions Compared with the POSSUM system,E-PASS system has higher clinical value and feasibility in evaluating postoperative complications of elderly patients with lumbar fracture,which is worthy of popularization and application.