手术发病率和死亡率的并发症指数的预测能力:系统性审查和元分析
Noah A Clements1, Jeremy T Gaskins1, Robert C G Martin2
1The Hiram C. Polk, Jr., MD Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA.
概括
五项修改后的脆弱性指数 (mFI-5) 比查尔森并发症指数 (CCI) 更好地预测像死亡率和并发症这样的手术结果. 脆弱性测量增加了手术患者的风险分层.
科学领域:
- 手术成果研究的研究结果.
- 医疗信息学医学信息学
- 老年医学 老年医学
背景情况:
- 查尔森并发症指数 (CCI) 自1987年以来一直是风险分层的标准.
- 许多当代并发症指数已经开发出来.
- 对这些指数对外科结果的预测效用进行比较至关重要.
研究的目的:
- 系统地审查和元分析在预测手术结果时常见的并发症指数的表现.
- 为了比较5项修改的脆弱性指数 (mFI-5) 与CCI和其他指数.
主要方法:
- 一项全面的文献审查发现了与手术结果相关的研究,这些研究将手术前的并发症措施与手术结果联系起来.
- 对111项研究的综合数据进行了元分析,这些研究涉及超过2500万名患者.
- 结果包括30天/住院和90天的发病/死亡率,以及严重的并发症.
主要成果:
- mFI-5显著预测了住院/30天死亡率 (OR: 1.97) 和严重并发症 (OR: 3.31) 的增加几率.
- CCI还预测住院/30天死亡率 (OR: 1.44) 的几率增加,但并没有预测严重的并发症.
- 基于规模的连续预测指标和分类指标显示,与住院/30天病率有显著的关联.
结论:
- 在预测短期死亡率和严重的手术并发症方面,mFI-5表现优于CCI.
- 结合脆弱度量的风险分层工具似乎比传统指数更能预测外科手术的结果.
- 脆弱性评估对于准确预测外科手术风险至关重要.
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