文章：

头对头比较：P-POSSUM与ACS-NSQIP®在妇科癌症机器人手术围术期风险评估中的预测效能对比

Head-to-Head Comparison: P-POSSUM and ACS-NSQIP®in Predicting Perioperative Risk in Robotic Surgery for Gynaecological Cancers

原文发布日期：22 June 2024

DOI: 10.3390/cancers16132297

类型: Article

开放获取: 是

英文摘要：

Purpose: In this retrospective pilot study, we aim to evaluate the accuracy and reliability of the P-POSSUM and ACS-NSQIP surgical risk calculators in predicting postoperative complications in gynaecological–oncological (GO) robotic surgery (RS).Methods: Retrospective data collection undertaken through a dedicated GO database and patient notes at a tertiary referral cancer centre. Following data lock with the actual post-op event/complication, the risk calculators were used to measure predictive scores for each patient. Baseline analysis of 153 patients, based on statistician advice, was undertaken to evaluate P-POSSUM and ACS-NSQIP validity and relevance in GO patients undergoing RS performed.Results: P-POSSUM reports on mortality and morbidity only; ACS-NSQIP reports some individual complications as well. ACS-NSQIP risk prediction was most accurate for venous thromboembolism (VTE) (area under the curve (AUC)-0.793) and pneumonia (AUC-0.657) and it showed 90% accuracy in prediction of five major complications (Brier score 0.01). Morbidity was much better predicted by ACS-NSQIP than by P-POSSUM (AUC-0.608 vs. AUC-0.551) with the same result in mortality prediction (Brier score 0.0000). Moreover, a statistically significant overestimation of morbidity has been shown by the P-POSSUM calculator (p= 0.018).Conclusions: Despite the limitations of this pilot study, the ACS-NSQIP risk calculator appears to be a better predictor of major complications and mortality, making it suitable for use by GO surgeons as an informed consent tool. Larger data collection and analyses are ongoing to validate this further.

摘要翻译： 

目的：在这项回顾性初步研究中，我们旨在评估P-POSSUM与ACS-NSQIP手术风险计算器在妇科肿瘤机器人手术术后并发症预测中的准确性与可靠性。 方法：通过三级转诊癌症中心的妇科肿瘤专科数据库及患者病历进行回顾性数据收集。在锁定实际术后事件/并发症数据后，使用风险计算器测算每位患者的预测评分。根据统计学建议，对153例患者进行基线分析，以评估P-POSSUM与ACS-NSQIP在接受机器人手术的妇科肿瘤患者中的有效性与相关性。 结果：P-POSSUM仅报告死亡率与发病率；ACS-NSQIP还可报告部分个体并发症。ACS-NSQIP对静脉血栓栓塞（曲线下面积0.793）和肺炎（曲线下面积0.657）的风险预测最为准确，对五大主要并发症的预测准确率达90%（Brier评分0.01）。在发病率预测方面，ACS-NSQIP显著优于P-POSSUM（曲线下面积0.608对比0.551），死亡率预测亦呈现相同趋势（Brier评分0.0000）。此外，P-POSSUM计算器显示出具有统计学意义的发病率高估现象（p=0.018）。 结论：尽管本研究存在局限性，但ACS-NSQIP风险计算器在主要并发症及死亡率预测方面表现更优，可作为妇科肿瘤外科医师的知情同意辅助工具。目前正在进行更大规模的数据收集与分析以进一步验证该结论。

原文链接：

Head-to-Head Comparison: P-POSSUM and ACS-NSQIP®in Predicting Perioperative Risk in Robotic Surgery for Gynaecological Cancers