预测术后死亡率的术前评分(POSPOM)
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Preoperative Score to Predict Postoperative Mortality (POSPOM)
背景与目的
准确的风险评分能够预测手术病人的住院死亡率，并能改善风险沟通和提高临床决策。本研究的目的是仅根据患者术前信息确定风险评分，以预测其住院死亡率。
方 法
采集2010年1月1日至2010年12月31日期间，法国所有年手术量超过500台的医疗中心（单个医院或医疗集团）中年龄≥18岁需要麻醉的外科手术患者(n = 5,507,834)。采用第10版修订国际疾病统计分类法，对病人的病史进行分类。 通过对获取的2，717，902名患者的29个术前因素(年龄、合并症和手术类型)进行了风险评分处理，并在另一组具有2,789,932名患者的独立队列研究中验证了风险评分的实用性。
结 果
在对照组中，院内死亡人数为12,786人（0.47%; 95% CI, 0.46 to 0.48%)，在实验组中，院内死亡人数为14,933人(0.54%; 95% CI, 0.53 to 0.55%).预测术后死亡率（POSPOM）的术前评分包含17个预测因子。当对照组和实验组的c统计量分别为0.944（95％CI，0.943至0.945）和0.929（95％CI，0.928至0.931）时，POSPOM在预测患者院内死亡率方面具有较好的敏感性和特异性。
结 论
本研究研发和验证了POSPOM是一种预测手术患者住院死亡率的简易风险评分。
原始文献摘要
Le M Y, Collins G, Rodseth R, et al. Preoperative Score to Predict Postoperative Mortality (POSPOM): Derivation and Validation.[J]. Anesthesiology, 2016, 124(3):570-579.
Background: An accurate risk score able to predict in-hospital mortality in patients undergoing surgery may improve both risk communication and clinical decision making. The aim of the study was to develop and validate a surgical risk score based solely on preoperative information, for predicting in-hospital mortality.
Methods: From January 1, 2010, to December 31, 2010, data related to all surgeries requiring anesthesia were collected from all centers (single hospital or hospitals group) in France performing more than 500 operations in the year on patients aged 18 yr or older (n = 5,507,834). International Statistical Classification of Diseases, 10th revision codes were used to summarize the medical history of patients. From these data, the authors developed a risk score by examining 29 preoperative factors (age, comorbidities, and surgery type) in 2,717,902 patients, and then validated the risk score in a separate cohort of 2,789,932 patients.
Results: In the derivation cohort, there were 12,786 in-hospital deaths (0.47%; 95% CI, 0.46 to 0.48%), whereas in the validation cohort there were 14,933 in-hospital deaths (0.54%; 95% CI, 0.53 to 0.55%). Seventeen predictors were identified and included in the PreOperative Score to predict PostOperative Mortality (POSPOM). POSPOM showed good calibration and excellent discrimination for in-hospital mortality, with a c-statistic of 0.944 (95% CI, 0.943 to 0.945) in the development cohort and 0.929 (95% CI, 0.928 to 0.931) in the validation cohort.
Conclusion: The authors have developed and validated POSPOM, a simple risk score for the prediction of in-hospital mortality in surgical patients
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