Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system previously validated in vascular and general surgical patients. The Portsmouth phy...Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system previously validated in vascular and general surgical patients. The Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) is a reliable tool derived from POSSUM to improve the prediction of mortality. In this paper, we utilized both models to determine the most suitable and feasible one that could be utilized in orthopedic surgery in China mainland. Methods: In this retrospective study, patients’ files were extracted randomly from the medical records department of the First Hospital Affiliated with Dalian Medical University for those underwent hip replacements between 1999 and 2006. The mortality and morbidity rates were predicted by P-POSSUM and POSSUM, respectively. A comparative analysis was performed between the observed and the predicted values as well as the Observed/Expected ratio (O:E). Results: A total of 206 patients were selected for this study after fulfilling the inclusion and exclusion criteria. The predicted mortality by P-POSSUM were not significantly different from the observed values (X2 = 2.10, P = 0.552). POSSUM appeared to be better with the observed morbidity (X2 = 2.766, P = 0.598), but had overestimated mortality. Conclusion: The POSSUM morbidity equation satisfactorily estimated the risk of postoperative complications, and the P-POSSUM mortality equation appeared to stratify the risk of death more accurate than the POSSUM.展开更多
PURPOSE: The Physiologic and Operative Severity Score for the enUmeration of M ortality and morbidity (POSSUM), Portsmouth revision (p)-POSSUM, and colorectal (Cr)-POSSUM scoring systems were developed as audit tools ...PURPOSE: The Physiologic and Operative Severity Score for the enUmeration of M ortality and morbidity (POSSUM), Portsmouth revision (p)-POSSUM, and colorectal (Cr)-POSSUM scoring systems were developed as audit tools for comparing outcomes in surgical and colorectal patients on the basis of operati ve risk assessment. The aim of this study was to evaluate the applicability of t hese systems to a cohort of colon cancer patients undergoing surgery in the Unit ed States. METHODS: POSSUM factors from 890 consecutive patients undergoing majo r surgical procedures for colon cancer in nine United States hospitals over a tw o-year period from January 2000 through December 2001 were prospectively collec ted. The observed over the expected hospital mortality was compared by means of the POSSUM, p-POSSUM, and Cr-POSSUM scoring systems. The effect of missing dat a on the utility of this process for outcome assessment was assessed with three methods for data imputation. RESULTS: The number of resections per institution r anged from 13 to 437. The observed mortality rate ranged from 0.8 percent to 15. 4 percent among the institutions, with an overall operative mortality of 2.3 per cent. The POSSUM, p-POSSUM, and Cr-POSSUM predicted mortality was 10.7 percent , 11.2 percent, and 4.9 percent, respectively. The POSSUM and p-POSSUM models o verpredicted mortality in all institutions (P < 0.01), whereas the Cr-POSSUM de monstrated an observed over expected hospital mortality ratio of >1 in three ins titutions. The calculations were unaffected by the various methods of inserting missing data. CONCLUSION: An apparent overprediction of mortality for colon canc er resection was evident with all three POSSUM variants. This implies that a cal ibration process is required for use of these variants in the United States heal th care system. Missing data may be treated as normal values without influencing outcome. The Cr-POSSUM appeared to be the most promising audit tool for colore ctal cancer surgery; however, it will require further refinement to provide proc ess control graphs for identification of potential outliers and improvement in t he quality of care in the United States.展开更多
PURPOSE:POSSUM(Physiologic and Operative Severity Score for enumeration of Morbidity &Mortality)and P-POSSUM have been validated as scoring tools for the prediction of postoperative complications in general surgic...PURPOSE:POSSUM(Physiologic and Operative Severity Score for enumeration of Morbidity &Mortality)and P-POSSUM have been validated as scoring tools for the prediction of postoperative complications in general surgical patients.More recently a colorectal-specific POSSUM has been developed for mortality prediction.This study was designed to evaluate and compare the accuracy for mortality prediction of POSSUM,P-POSSUM,and colorectal POSSUM after major and complex major colorectal procedures.METHODS:The relationship between the observed and expected morbidity and mortality was examined in 347 consecutive patients(321 elective,26 urgent)undergoing amajor or complex major colorectal resection using POSSUM,P-POSSUM,and Colorectal POSSUM.The accuracy of using these scoring tools to predict mortality was assessed using Receiver Operator Characteristic curve analysis.RESULTS:A total of 347 consecutive patients(median age,69(range,34-92)years)were assessed.Seventy-one patients(20.5 percent)suffered a postoperative complication and 15 patients(4.3 percent)died.The observed∶expected POSSUM ratio for morbidity was 0.71 and mortality 0.68.The area under curve from Receiver Operator Characteristic curve analysis for POSSUM was 0.752.The observed∶expected mortality ratio for P-POSSUM was 0.71,and the area under curve from Receiver Operator Characteristic curve analysis was 0.749.The observed∶expected mortality ratio for colorectal POSSUM was 0.75,and the area under the curve from Receiver Operator Characteristic curve analysis was 0.781.CONCLUSIONS:Colorectal POSSUM provides comparable prediction of mortality risk after colorectal resection compared with POSSUM and P-POSSUM.展开更多
背景与目的对于评价老年患者能否耐受肺癌手术,目前尚无明确标准。本研究旨在探讨改良POSSUM(Physiological and Operative Severity Score for the Umeration of Mortality and Morbidity)评分在预测老年非小细胞肺癌(non-small cell l...背景与目的对于评价老年患者能否耐受肺癌手术,目前尚无明确标准。本研究旨在探讨改良POSSUM(Physiological and Operative Severity Score for the Umeration of Mortality and Morbidity)评分在预测老年非小细胞肺癌(non-small cell lung cancer,NSCLC)患者术后并发症发生率和病死率中的应用价值,为手术治疗的决策提供重要依据。方法 2007年12月-2013年12月在解放军总医院接受手术治疗的老年NSCLC患者138例,其中男性88例,女性50例,收集临床资料,各因素对术后实际并发症发生率和病死率的影响,采用二值多元Logistic回归分析。在有、无并发症两组中,采用成组t检验对标准及改良POSSUM评分值进行比较。绘制标准POSSUM和改良POSSUM的受试者工作特征曲线(receiver operating characteristic curve,ROC),计算曲线下面积(area under the curve,AUC),两组间AUC比较采用t检验。计算改良POSSUM评分预测值和实际并发症发生率和病死率的符合度。结果共有59例患者出现77例次术后并发症,手术死亡2例。Logistic回归分析,标准POSSUM的18项指标中17项及肺功能、肿瘤分期对术后并发症的发生有统计学意义(P<0.05),年龄对术后死亡有统计学意义(P<0.05)。在标准POSSUM评分中,并发症组与无并发症组的评分比较,差异有统计学意义(P<0.01)。在改良POSSUM评分中,并发症组与无并发症组的评分比较,差异有统计学意义(P<0.01)。改良POSSUM较标准POSSUM对术后并发症发生有更好的预测价值,两组AUC比较,差异有统计学意义(P<0.01)。但改良POSSUM对手术死亡的预测值过高。结论改良POSSUM评分对老年NSCLC术后并发症发生有较好的预测价值,可为决策手术治疗提供依据。展开更多
文摘Background: The physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) is a scoring system previously validated in vascular and general surgical patients. The Portsmouth physiological and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) is a reliable tool derived from POSSUM to improve the prediction of mortality. In this paper, we utilized both models to determine the most suitable and feasible one that could be utilized in orthopedic surgery in China mainland. Methods: In this retrospective study, patients’ files were extracted randomly from the medical records department of the First Hospital Affiliated with Dalian Medical University for those underwent hip replacements between 1999 and 2006. The mortality and morbidity rates were predicted by P-POSSUM and POSSUM, respectively. A comparative analysis was performed between the observed and the predicted values as well as the Observed/Expected ratio (O:E). Results: A total of 206 patients were selected for this study after fulfilling the inclusion and exclusion criteria. The predicted mortality by P-POSSUM were not significantly different from the observed values (X2 = 2.10, P = 0.552). POSSUM appeared to be better with the observed morbidity (X2 = 2.766, P = 0.598), but had overestimated mortality. Conclusion: The POSSUM morbidity equation satisfactorily estimated the risk of postoperative complications, and the P-POSSUM mortality equation appeared to stratify the risk of death more accurate than the POSSUM.
文摘PURPOSE: The Physiologic and Operative Severity Score for the enUmeration of M ortality and morbidity (POSSUM), Portsmouth revision (p)-POSSUM, and colorectal (Cr)-POSSUM scoring systems were developed as audit tools for comparing outcomes in surgical and colorectal patients on the basis of operati ve risk assessment. The aim of this study was to evaluate the applicability of t hese systems to a cohort of colon cancer patients undergoing surgery in the Unit ed States. METHODS: POSSUM factors from 890 consecutive patients undergoing majo r surgical procedures for colon cancer in nine United States hospitals over a tw o-year period from January 2000 through December 2001 were prospectively collec ted. The observed over the expected hospital mortality was compared by means of the POSSUM, p-POSSUM, and Cr-POSSUM scoring systems. The effect of missing dat a on the utility of this process for outcome assessment was assessed with three methods for data imputation. RESULTS: The number of resections per institution r anged from 13 to 437. The observed mortality rate ranged from 0.8 percent to 15. 4 percent among the institutions, with an overall operative mortality of 2.3 per cent. The POSSUM, p-POSSUM, and Cr-POSSUM predicted mortality was 10.7 percent , 11.2 percent, and 4.9 percent, respectively. The POSSUM and p-POSSUM models o verpredicted mortality in all institutions (P < 0.01), whereas the Cr-POSSUM de monstrated an observed over expected hospital mortality ratio of >1 in three ins titutions. The calculations were unaffected by the various methods of inserting missing data. CONCLUSION: An apparent overprediction of mortality for colon canc er resection was evident with all three POSSUM variants. This implies that a cal ibration process is required for use of these variants in the United States heal th care system. Missing data may be treated as normal values without influencing outcome. The Cr-POSSUM appeared to be the most promising audit tool for colore ctal cancer surgery; however, it will require further refinement to provide proc ess control graphs for identification of potential outliers and improvement in t he quality of care in the United States.
文摘PURPOSE:POSSUM(Physiologic and Operative Severity Score for enumeration of Morbidity &Mortality)and P-POSSUM have been validated as scoring tools for the prediction of postoperative complications in general surgical patients.More recently a colorectal-specific POSSUM has been developed for mortality prediction.This study was designed to evaluate and compare the accuracy for mortality prediction of POSSUM,P-POSSUM,and colorectal POSSUM after major and complex major colorectal procedures.METHODS:The relationship between the observed and expected morbidity and mortality was examined in 347 consecutive patients(321 elective,26 urgent)undergoing amajor or complex major colorectal resection using POSSUM,P-POSSUM,and Colorectal POSSUM.The accuracy of using these scoring tools to predict mortality was assessed using Receiver Operator Characteristic curve analysis.RESULTS:A total of 347 consecutive patients(median age,69(range,34-92)years)were assessed.Seventy-one patients(20.5 percent)suffered a postoperative complication and 15 patients(4.3 percent)died.The observed∶expected POSSUM ratio for morbidity was 0.71 and mortality 0.68.The area under curve from Receiver Operator Characteristic curve analysis for POSSUM was 0.752.The observed∶expected mortality ratio for P-POSSUM was 0.71,and the area under curve from Receiver Operator Characteristic curve analysis was 0.749.The observed∶expected mortality ratio for colorectal POSSUM was 0.75,and the area under the curve from Receiver Operator Characteristic curve analysis was 0.781.CONCLUSIONS:Colorectal POSSUM provides comparable prediction of mortality risk after colorectal resection compared with POSSUM and P-POSSUM.
文摘背景与目的对于评价老年患者能否耐受肺癌手术,目前尚无明确标准。本研究旨在探讨改良POSSUM(Physiological and Operative Severity Score for the Umeration of Mortality and Morbidity)评分在预测老年非小细胞肺癌(non-small cell lung cancer,NSCLC)患者术后并发症发生率和病死率中的应用价值,为手术治疗的决策提供重要依据。方法 2007年12月-2013年12月在解放军总医院接受手术治疗的老年NSCLC患者138例,其中男性88例,女性50例,收集临床资料,各因素对术后实际并发症发生率和病死率的影响,采用二值多元Logistic回归分析。在有、无并发症两组中,采用成组t检验对标准及改良POSSUM评分值进行比较。绘制标准POSSUM和改良POSSUM的受试者工作特征曲线(receiver operating characteristic curve,ROC),计算曲线下面积(area under the curve,AUC),两组间AUC比较采用t检验。计算改良POSSUM评分预测值和实际并发症发生率和病死率的符合度。结果共有59例患者出现77例次术后并发症,手术死亡2例。Logistic回归分析,标准POSSUM的18项指标中17项及肺功能、肿瘤分期对术后并发症的发生有统计学意义(P<0.05),年龄对术后死亡有统计学意义(P<0.05)。在标准POSSUM评分中,并发症组与无并发症组的评分比较,差异有统计学意义(P<0.01)。在改良POSSUM评分中,并发症组与无并发症组的评分比较,差异有统计学意义(P<0.01)。改良POSSUM较标准POSSUM对术后并发症发生有更好的预测价值,两组AUC比较,差异有统计学意义(P<0.01)。但改良POSSUM对手术死亡的预测值过高。结论改良POSSUM评分对老年NSCLC术后并发症发生有较好的预测价值,可为决策手术治疗提供依据。
