An Evaluation Of POSSUM And P-POSSUM Surgical Risk Scoring For The General Surgery

Object: With the application of organ function monitoring and supporting the progress of treatment, medical technology and equipment to improve the level of development, many critically ill patients to salvage successful preoperative mortality has been greatly reduced, pre-operative to conduct a comprehensive assessment of patients are reduce preoperative complications and mortality rate one of the effective. The past, there is a lot of scoring system for prediction of surgical mortality and complications in patients with the crisis, but most methods of simplicity and accuracy is not high and not an universal system, its applications are subject to certain limitations; original easy to rely on mortality and complication rate assessments are too subjective and vague. Recently POSSUM and P-POSSUM in many European and American countries have become sick preoperative assessment of conventional, is the most popular instrument. At the same time, the domestic application of the POSSUM scoring system has been slower, especially in the past the scoring system study at retrospective study using more and less prospective study, which is obviously inadequate. The purpose of this study to the adoption of pre-operative POSSUM, P-POSSUM, respectively, of patients with complications, mortality prediction and the actual postoperative complications, mortality rates were compared, using Logistic and ROC, prediction and the actual mortality rate (concurrent disease) in line with the degree of statistical methods, analysis and evaluation of prospective study of POSSUM, P-POSSUM and many preoperative factors on postoperative complications in gastrointestinal surgery countrymen and mortality prediction accuracy. Method: By POSSUM and P-POSSUM for November 2007 to November 2008 Luzhou Medical College Hospital Department of General Surgery, Affiliated Hospital treated all patients with gastrointestinal surgery 633 prospective studies. To POSSUM and P-POSSUM scoring system, whichever is the indicator, at the same time selected and associated with the clinical experience reported prone to complications and death of the clinical effects of common factors as a reference, the collection of patient information to POSSUM prediction of its complications rate and P-POSSUM predicted mortality rate, and measured analysis of comparative study group. Logistic regression analysis to explore the post-operative complications and death related factors, the application of non-parametric independent samples T test (Independent-Samples T Test) analysis of surgical risk score in the group without complications, complications and death whether or not the differences between the groups. The area under receiver operating characteristic curve , prediction and the actual mortality (complications) in line with the degree of (OE ratio) evaluation of statistical methods POSSUM prediction accuracy. Results: POSSUM and general surgery patients with complications and mortality were significantly correlated, the number of complications for the prediction of 229 peoples, the actual number of 188 peoples, prediction of death for 44 peoples, the actual number of deaths of 34 peoples, after statistical analysis of the two There was no statistically significant difference (p> 0.05); in high-risk units (R1>38,R2>50) more prediction accuracy of prediction and the actual mortality (complications) in line with the degree of (OE ratio) equal 1, while in low-risk group (R1<38,R2<50) are over-estimated his death incidence, prediction and the actual mortality (complications) in line with the degree of (OE ratio) is greater than 1. Prediction and the actual mortality (complications) in line with the degree of (OE ratio) equal 1, while in low-risk group (R1<38,R2<50) are over-estimated his death incidence, prediction and the actual mortality (complications) in line with the degree of (OE ratio ) is greater than one. POSSUM prediction of complications in the area under the ROC curve for the 0.802, P-POSSUM mortality prediction of area under the ROC curve for the 0.922. Logistic regression analysis of many factors, liver function, blood glucose, body height ratio, operation time and intraoperative blood pressure stable factors on postoperative complications and mortality also are related to each other. Conclusion: For gastrointestinal surgical patients, POSSUM prediction of their complication rate and P-POSSUM mortality prediction has a good correlation of general surgery patients comparing audit and the prevention of surgical complications and death provides a more precise method. POSSUM also exist at the same time the lack of some essential organ function and subjective indicators is too large, such as lack of need to be improved.