학술논문
Development and validation of a prognostic model for death 30 days after adult emergency laparotomy.
Document Type
Academic Journal
Author
Eugene N; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.; Kuryba A; Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.; Martin P; Department of Applied Health Research, University College London, London, UK.; Oliver CM; UCL Division of Surgery and Interventional Science, University College London Hospitals NHS Foundation Trust, London, UK.; Berry M; Critical Care, King's College Hospital NHS Foundation Trust, London, UK.; Moppett IK; Anaesthesia and Critical Care Section, Academic Unit of Injury, Inflammation and Repair, University of Nottingham, Nottingham, UK.; Johnston C; Department of Anaesthesia, St George's Hospital, London, UK.; Hare S; Department of Anaesthesia, Medway Maritime Hospital, Gillingham, Kent, UK.; Lockwood S; Colorectal Surgery Department, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK.; Murray D; Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK.; Walker K; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.; Cromwell DA; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Source
Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 0370524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2044 (Electronic) Linking ISSN: 00032409 NLM ISO Abbreviation: Anaesthesia Subsets: MEDLINE
Subject
Language
English
Abstract
The probability of death after emergency laparotomy varies greatly between patients. Accurate pre-operative risk prediction is fundamental to planning care and improving outcomes. We aimed to develop a model limited to a few pre-operative factors that performed well irrespective of surgical indication: obstruction; sepsis; ischaemia; bleeding; and other. We derived a model with data from the National Emergency Laparotomy Audit for patients who had emergency laparotomy between December 2016 and November 2018. We tested the model on patients who underwent emergency laparotomy between December 2018 and November 2019. There were 4077/40,816 (10%) deaths 30 days after surgery in the derivation cohort. The final model had 13 pre-operative variables: surgical indication; age; blood pressure; heart rate; respiratory history; urgency; biochemical markers; anticipated malignancy; anticipated peritoneal soiling; and ASA physical status. The predicted mortality probability deciles ranged from 0.1% to 47%. There were 1888/11,187 deaths in the test cohort. The scaled Brier score, integrated calibration index and concordance for the model were 20%, 0.006 and 0.86, respectively. Model metrics were similar for the five surgical indications. In conclusion, we think that this prognostic model is suitable to support decision-making before emergency laparotomy as well as for risk adjustment for comparing organisations.
(© 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)
(© 2023 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.)