消化器外科緊急手術における外科技術評価法Ｐｈｙｓｉｏｌｏｇｉｃａｌ　ａｎｄ　Ｏｐｅｒａｔｉｖｅ　Ｓｅｖｅｒｉｔｙ　Ｓｃｏｒｅ　ｆｏｒ　ｔｈｅ　ｅｎＵｍｅｒａｔｉｏｎ　ｏｆ　Ｍｏｒｔａｌｉｔｙ　ａｎｄ　ｍｏｒｂｉｄｉｔｙ（ＰＯＳＳＵＭ）およびＰ‐ＰＯＳＳＵＭの評価

• 岩槻 政晃

  熊本大学大学院医学薬学研究部消化器外科学 国立病院機構熊本医療センター外科

• 芳賀 克夫

  国立病院機構熊本医療センター外科

• 片渕 茂

  国立病院機構熊本医療センター外科

• 池井 聰

  国立病院機構熊本医療センター外科

• 馬場 秀夫

  熊本大学大学院医学薬学研究部消化器外科学

書誌事項

タイトル別名

• Evaluation of Surgical Audit Systems 'POSSUM and P-POSSUM' in Emergency Digestive Surgery

抄録

Background: We evaluated the accuracy of surgical auditing systems, POSSUM and P-POSSUM, developed in the United Kingdom, in emergency digestive surgery. Patients and Methods: Using POSSUM and PPOSSUM, we calculated expected mortality in 294 patients who underwent emergency digestive surgery from January 2001 to December 2003.In the original literature, the endpoint for POSSUM was defined as 30-day mortality and that for P-POSSUM as the in-hospital mortality. The ratio of observed to expected mortality rates (OE ratio) was defined as a measure of accuracy. Results: Overall morbidity was 20.7%, 30-day mortality 6.5%, and in-hospital mortality 7.1%. POSSUM overpredicted mortality rates at a low-risk band where expected rates were 0 to 49%-observed-rate 2/249, 0.80%, vs. expected rate 33/249, 13.3%: OE ratio 0.061 with 95% confidence intervals (CI) of 0.015-0.25. Expected rates were comparable to observed rates at a high-risk band where expected rates were 50 to 100%-observed-rate 17/45, 37.7% vs. expected rate 23/45, 51.1%; the OE ratio 0.74 with 95% CI of 0.46-1.12.Similarly, P-POSSUM overpredicted mortality rates at a low-risk band where expected rates were 0 to 59%-observed rate 6/267, 2.2% vs. expected rate 24/267, 9.0%: OE ratio 0.23 with 95% CI of 0.094-0.58. In contrast, expected rates were closer to the observed rates at a high-risk band where the expected rates were 60 to 100%-observed rate 15/27, 55.6% vs. expected rate 22/27, 81.5%: OE ratio 0.68 with 95% CI of 0.47-1.00.Conclusion: Current single-center data suggests that both POSSUM and P-POSSUM may overpredict mortality rates in low-risk patients who undergo emergency digestive surgery.

収録刊行物

• 日本消化器外科学会雑誌

  日本消化器外科学会雑誌 41 (4), 373-379, 2008

  一般社団法人 日本消化器外科学会

キーワード

• POSSUM
• P-POSSUM
• emergency digestive surgery

詳細情報

• CRID: 1390001204919074560
• NII論文ID: 130004117600
• NII論文ID: 110006655904
• NII書誌ID: AN00192066
• DOI: 10.5833/jjgs.41.373
• ISSN: 13489372
• ISSN: 03869768
• Web Site: https://www.jstage.jst.go.jp/article/jjgs1969/41/4/41_4_373/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2008181104
• 本文言語コード: ja
• データソース種別:
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  • Crossref
  • CiNii Articles
• 抄録ライセンスフラグ: 使用不可