POSSUM系统预测高龄患者术后并发症的临床适用范围

Clinical application of POSSUM in predicting postoperative complications in elderly patients

关键词:  预测  手术  并发症  高龄

Key words:  prediction  operation  complication  advanced age

摘要:

目的 探讨生理学和手术严重程度评分系统(POSSUM)对高龄骨科髋关节手术和非骨科、非同类患者的临床适用范围。方法 应用POSSUM系统评分并计算术后并发症发生率的理论预测值,比较100例骨科高龄髋关节置换手术患者与200例非骨科、非同类手术患者的术后并发症发生率预测值与实际值差异以及各自有无并发症组间差异。结果骨科高龄髋关节置换手术患者术后并发症发生率预测值(42.04％)与实际值(22％)差异有统计学意义(χ²=9.191,P=0.002)；有、无并发症组生理指标评分[(25.05±5.05)分vs(24.49±5.40)分, Z=-0.80, P=0.936]、手术严重度评分[(10.14±0.83)分vs(9.96±0.86)分, Z=-1.086, P=0.278]、并发症预测值[(44.22±18.48)%vs(41.56±18.47)%, Z=-0.325, P=0.746]差异均无统计学意义。非骨科、非同类手术患者术后并发症发生率预测值(47.33％)与实际值(19％)间差异无统计学意义(Z=-1.826,P=0.086)；有、无并发症组间手术严重度评分[(10.42±1.57)分vs(10.47±2.16)分, Z=-0.477, P=0.633]差异无统计学意义,而生理指标评分[(26.53±5.97)分vs(23.18±4.55)分, Z=-3.122, P=0.002]和并发症预测值[(55.96±20.17)%vs(45.32±18.61)%, Z=-2.853,P=0.004]差异有统计学意义。结论 POSSUM评分对高龄手术患者术后并发症的预测值高于实际观察值；POSSUM评分系统可作为非骨科、非同类患者的术前风险评估工具,对骨科高龄手术患者的适用性有待进一步探讨。

Abstract:

Objective To evaluate the clinical application of POSSUM in elderly patients undergoing orthopedic hip replacement surgery, non-orthopedic surgery or surgery of different category. MethodsThe predicted value of postoperative complication rate according to POSSUM system was scored and calculated. Differences between the predicted value and the actual value in 100 patients aged≥70 years undergoing orthopedic hip replacement surgery and 200 patients≥70 years undergoing non-orthopedic surgery or surgery of different category were analyzed. Results There was a significant difference in postoperative complication rate between the predicted value and the actual value (42.04% vs 22%, χ²=9.191, P=0.002) in patients undergoing orthopedic hip replacement surgery. There were no significant differences in mean physiological index score [(25.05±5.05) vs (24.49±5.40), Z=-0.80, P=0.936 ], mean operative severity score [(10.14±0.83) vs (9.96±0.86). Z=-1.086, P=0.278], and prediction values (44.22±18.48)% vs (41.56±18.47)%, Z=-0.325, P=0.746] between patients with and without postoperative complications. There was no significant difference in postoperative complication rate between prediction value and actual value (47.33% vs 19%, Z=-1.826, P=0.086) in patients undergoing non-orthopedic surgery or surgery of different category. There was no statistical difference in mean operative severity score [(10.42 ± 1.57) vs (10.47±2.16), Z=-0.477, P=0.633], but there were significant differences in physiological index mean score [(26.53±5.97)vs (23.18±4.55), Z=-3.122, P=0.002] and prediction values [(55.96±20.17)%vs (45.32±18.61)%, Z=-2.853, P=0.004] between patients with and without postoperative complications. Conclusion The predictive value of POSSUM for postoperative complications in elderly patients is higher than the actual value. POSSUM can be used as a preoperative risk assessment tool for patients undergoing non-orthopedic or surgery of different category, while its application in patients undergoing orthopedic hip replacement surgery need to be further explored.