脆弱性评估可以增强当前的风险预测工具在紧急 laparotomy:一个回顾性队列研究
Karl G Isand1, Shoaib Hussain2, Maseh Sadiqi2
1Faculty of Medicine, Tartu University, Sütiste Tee 19, 13419, Tallinn, Tartu, Estonia. isandkarl@gmail.com.
World journal of surgery
|August 17, 2023
概括
将临床脆弱度量 (CFS) 与P-POSSUM和NELA风险工具相结合,可以显著改善紧急腹腔切除术 (EL) 患者的风险预测,特别是老年人. 脆弱性独立地预测了跨年龄组的EL患者的30天死亡率.
科学领域:
- 手术风险分层的分层化
- 老年医学 老年医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 紧急腹腔切除术 (EL) 的死亡率很高,特别是在脆弱的老年患者中.
- 目前的风险预测工具,如P-POSSUM和NELA RPT,没有充分纳入患者的脆弱性.
- 准确的风险评估对于资源分配,临床决策和知情同意至关重要.
研究的目的:
- 评估P-POSSUM和NELA风险预测工具 (RPT) 的性能.
- 确定是否整合临床虚弱度表 (CFS) 增强了这些风险预测模型.
- 评估虚弱对紧急腹腔切除术后30天死亡率的影响.
主要方法:
- 对NELA数据库病例的回顾性单中心队列研究 (2018年1月1日 - 2021年6月15日).
- 对P-POSSUM和NELA RPT表现的分析.
- 修改了这两种工具,将临床脆弱度量 (CFS) 纳入其中.
主要成果:
- 无论是P-POSSUM还是NELA RPT都表现出良好的歧视,老年人的表现略有下降.
- 添加CFS显著改善了老年患者的P-POSSUM和NELA RPT性能 (AUC分别从0.775增加到0.846和0.814增加到0.864).
- 在65岁以上的患者中,CFS与30天死亡率有关,在年轻患者中影响较小.
结论:
- 将P-POSSUM和NELA RPT与CFS结合起来,可以显著提高风险预测的准确性.
- 临床虚弱度尺度是预测紧急腹腔切除术后30天死亡率的关键因素.
- 虚弱对死亡率的影响在所有年龄组都很明显,尽管在老年人中更为明显.
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