The Development And Application Of Operative Risk Assessment Software 1 (Orthopaedics Section ORAS1)

Objective: To develop an operative risk assessment software1(ORAS1) (orthopaedics section) for orthopaedics surgeon to assessthe operative risk of the elderly patients with hip fracture undergoingsome kinds of operation and to facilitate the management of clinicalmaterials. This article expound the thought of the development andapplication of ORAS1, the choices of development and operationenvironment, the overall configuration of the system, databasemanagement and application of methods, systems features, systemfunctions and other functions of the software systematically. Making reference to the international universal POSSUM scoringprojects, mortality formula (R1) and morbidity (R2) 【R1:ln R1/(1-R1)= -7.04+0.13 X PS+0.16 X OS;R2:ln R2/(1-R2)= -5.91+0.16 X PS+0.19 X OS. PS: Physiological Score;OS: Operative severity Score】and Apply Client/Server (client/server C/S) model databasemanagement system and a set of editing tools Power Builder8.0 to editdetailed records of the status of patients. It could be given a numberbased on the patient's physiological scores, operative severity scoresand Glasgow Coma Scale before the surgery, so as to quantify thepatient's mortality and morbidity, and to assess the risk of surgery ofthe patients ultimately and do clinical sections management of thepatients. Methords: 90 patients (33men and 57 women) aged 60 years andmore elderly (mean age 71.83±7.42) with hip fracture who wereadmitted to the orthopaedics department of the first affiliated hospitalof Jilin university between March 2003 and March 2006 have beenstudied prospectively with ORAS1.The preoperative physiologicalscores were obtained and multivariate analyses were performed.Results: The mean PS in the group of 28 with complication weresignificantly higher than that of the group of 62 without complication.There was no statistically difference between the patients withcomplication predicted by ORAS1 and the observed (34 and 28). Only3 patients in this group died after operation. The average PS in thedeath group were significantly higher than that of `the living group.Though ORAS1 overpredict the overall risk of death, it produces avery close fit in the high risk band (6 percent or more). There wasperfect agreement between the observed and the predicted morbidityas calculated by POSSUM equation.Conclusions: ORAS1 can be used to predict operative riskrapidly and conveniently and to predict the morbidity and mortalityalthough it overpredict the overall risk of death in elderly patients withhip fracture and may be use to facilitate the management and casechecking of clinical materials...