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
書誌事項
- タイトル別名
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- Evaluation of Surgical Audit Systems 'POSSUM and P-POSSUM' in Emergency Digestive Surgery
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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
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- 日本消化器外科学会雑誌
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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
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詳細情報 詳細情報について
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- CRID
- 1390001204919074560
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- NII論文ID
- 130004117600
- 110006655904
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- NII書誌ID
- AN00192066
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- ISSN
- 13489372
- 03869768
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- 本文言語コード
- ja
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- データソース種別
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- JaLC
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- 抄録ライセンスフラグ
- 使用不可