Year 2019 / Volume 111 / Number 9
Original
The Urgent Surgery Elderly Mortality risk score: a simple mortality score

677-682

DOI: 10.17235/reed.2019.6187/2019

Inés Eguaras Córdoba, Javier Herrera Cabezón, Pablo Sánchez Acedo, Arkaitz Galbete Jiménez, Francisco Guillén Grima,

Abstract
Introduction: an increasing number of elderly patients undergo urgent abdominal surgery and this population has a higher risk of mortality. The main objective of the study was to identify mortality-associated factors in elderly patients undergoing abdominal surgery and to design a mortality scoring tool, the Urgent Surgery Elderly Mortality risk score (the USEM score). Patients and methods: this was a retrospective study using a prospective database. Patients > 65 years old that underwent urgent abdominal surgery were included. Risk factors for 30-day mortality were identified using multivariate regression analysis and weights assigned using the odds ratios (OR). A mortality score was derived from the aggregate of weighted scores. Model calibration and discrimination were judged using the receiver operating characteristics curves and the Hosmer-Lemeshow test. Results: in the present study, 4,255 patients were included with an 8.5% mortality rate. The risk factors significantly associated with mortality were American Society of Anesthesiologists (ASA) score, age, preoperative diagnosis (OR: 37.82 for intestinal ischemia, OR: 5.01 for colorectal perforation, OR: 6.73 for intestinal obstruction), surgical wound classification and open or laparoscopic surgery. A risk score was devised from these data for the estimation of the probability of survival in each patient. The area under the ROC curve (AUROC) for this score was 0.84 (95% CI: 0.82-0.86) and the AUROC correct was 0.83 (0.81-0.85). Conclusions: a simple score that uses five clinical variables predicts 30-day mortality. This model can assist surgeons in the initial evaluation of an elderly patient undergoing urgent abdominal surgery.
Share Button
New comment
Comments

12/02/2021 0:39:54
This is an important step towards prognostic certainty which will better inform decision-making for older patients. A valuable contribution to knowledge that should be promoted across surgical services. Dr Magnolia Cardona, Associate Professor of Health Systems Research and Translation, Australia.


References
1. Torrance ADW, Powell SL, Griffiths EA. Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med OAEM. 2015 Sep 8;7:55–68.
2. Partridge JSL, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing. 2012 Mar;41(2):142–7.
3. Enred-indicadoresbasicos16.indd - enred-indicadoresbasicos16.pdf [Internet]. 2017 [cited 2017 Nov 11]. Available from: http://envejecimiento.csic.es/documentos/documentos/enred-indicadoresbasicos16.pdf
4. Gazala S, Tul Y, Wagg A, Widder SL, Khadaroo RG. Quality of life and long-term outcomes of octo- and nonagenarians following acute care surgery: a cross sectional study. World J Emerg Surg WJES. 2013 Jul 1;8:23.
5. Gale SC, Shafi S, Dombrovskiy VY, Arumugam D, Crystal JS. The public health burden of emergency general surgery in the United States: A 10-year analysis of the Nationwide Inpatient Sample--2001 to 2010. J Trauma Acute Care Surg. 2014 Aug;77(2):202–8.
6. Shah AA, Latif A, Zogg CK, Zafar SN, Riviello R, Halim MS, et al. Emergency general surgery in a low-middle income health care setting: Determinants of outcomes. Surgery. 2016 Feb;159(2):641–9.
7. Ingraham AM, Cohen ME, Bilimoria KY, Raval MV, Ko CY, Nathens AB, et al. Comparison of 30-day outcomes after emergency general surgery procedures: potential for targeted improvement. Surgery. 2010 Aug;148(2):217–38.
8. Havens JM, Peetz AB, Do WS, Cooper Z, Kelly E, Askari R, et al. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg. 2015 Feb;78(2):306–11.
9. POSSUM: a scoring system for surgical audit. - PubMed - NCBI [Internet]. 2017 [cited 2017 Nov 11]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/2021856
10. POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity. - PubMed - NCBI [Internet]. 2017 [cited 2017 Nov 11]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/9752863
11. Jones DR, Copeland GP, de Cossart L. Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit. Br J Surg. 1992 Dec;79(12):1293–6.
12. A new and feasible model for predicting operative risk. - PubMed - NCBI [Internet]. 2017 [cited 2017 Nov 11]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15220171
13. Abbas SM, Kahokehr A, Mahmoud M, Hill AG. The Simple Prognostic Index (SPI)--a pathophysiologic prognostic scoring tool for emergency laparotomy. J Surg Res. 2010 Oct;163(2):e59-65.
14. Nandan AR, Bohnen JD, Sangji NF, Peponis T, Han K, Yeh DD, et al. The Emergency Surgery Score (ESS) accurately predicts the occurrence of postoperative complications in emergency surgery patients. J Trauma Acute Care Surg. 2017 Jul;83(1):84–9.
15. Derivation and validation of a novel Emergency Surgery Acuity Score (ESAS). - PubMed - NCBI [Internet]. 2017 [cited 2017 Nov 11]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27032007
16. Protopapa KL, Simpson JC, Smith NCE, Moonesinghe SR. Development and validation of the Surgical Outcome Risk Tool (SORT). Br J Surg. 2014 Dec;101(13):1774–83.
17. Fukuda N, Wada J, Niki M, Sugiyama Y, Mushiake H. Factors predicting mortality in emergency abdominal surgery in the elderly. World J Emerg Surg WJES. 2012 May 11;7(1):12.
18. Joseph B, Zangbar B, Pandit V, Fain M, Mohler MJ, Kulvatunyou N, et al. Emergency General Surgery in the Elderly: Too Old or Too Frail? J Am Coll Surg. 2016 May;222(5):805–13.
19. Kim S, Han H-S, Jung H, Kim K, Hwang DW, Kang S-B, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg. 2014 Jul;149(7):633–40.
20. Nandan AR, Bohnen JD, Sangji NF, Peponis T, Han K, Yeh DD, et al. The Emergency Surgery Score (ESS) accurately predicts the occurrence of postoperative complications in emergency surgery patients. J Trauma Acute Care Surg. 2017 Jul;83(1):84–9.
21. Garner JS. CDC guideline for prevention of surgical wound infections, 1985. Supersedes guideline for prevention of surgical wound infections published in 1982. (Originally published in November 1985). Revised. Infect Control IC. 1986 Mar;7(3):193–200.
22. Adams ST, Leveson SH. Clinical prediction rules. BMJ. 2012 Jan 16;344:d8312.
23. Liao L, Mark DB. Clinical prediction models: are we building better mousetraps? J Am Coll Cardiol. 2003 Sep 3;42(5):851–3.
24. Moonesinghe SR, Mythen MG, Das P, Rowan KM, Grocott MPW. Risk stratification tools for predicting morbidity and mortality in adult patients undergoing major surgery: qualitative systematic review. Anesthesiology. 2013 Oct;119(4):959–81.
25. Bennett-Guerrero E, Hyam JA, Shaefi S, Prytherch DR, Sutton GL, Weaver PC, et al. Comparison of P-POSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK. Br J Surg. 2003 Dec;90(12):1593–8.
26. Al-Temimi MH, Griffee M, Enniss TM, Preston R, Vargo D, Overton S, et al. When is death inevitable after emergency laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg. 2012 Oct;215(4):503–11.
27. Arenal JJ, Bengoechea-Beeby M. Mortality associated with emergency abdominal surgery in the elderly. Can J Surg J Can Chir. 2003 Apr;46(2):111–6.
28. Sutton R, Bann S, Brooks M, Sarin S. The Surgical Risk Scale as an improved tool for risk-adjusted analysis in comparative surgical audit. Br J Surg. 2002 Jun;89(6):763–8.
29. Gil-Bona J, Sabaté A, Bovadilla M, María J, Adroer R, Koo M, et al. Valor de los índices de Charlson y la escala de riesgo quirúrgico en el análisis de la mortalidad operatoria. Cir Esp. :174–9.
30. Al-Temimi MH, Griffee M, Enniss TM, Preston R, Vargo D, Overton S, et al. When is death inevitable after emergency laparotomy? Analysis of the American College of Surgeons National Surgical Quality Improvement Program database. J Am Coll Surg. 2012 Oct;215(4):503–11.
31. Carpenter CR, Shelton E, Fowler S, Suffoletto B, Platts-Mills TF, Rothman RE, et al. Risk factors and screening instruments to predict adverse outcomes for undifferentiated older emergency department patients: a systematic review and meta-analysis. Acad Emerg Med Off J Soc Acad Emerg Med. 2015 Jan;22(1):1–21.
32. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017 Aug 1;152(8):784–91.
33. AXA PPP healthcare | Specialist Procedure Codes [Internet]. [cited 2017 Dec 11]. Available from: https://online.axappphealthcare.co.uk/SpecialistForms/SpecialistCode.mvc?source=published
34. Joseph B, Zangbar B, Pandit V, Kulvatunyou N, Haider A, O’Keeffe T, et al. Mortality after trauma laparotomy in geriatric patients. J Surg Res. 2014 Aug;190(2):662–6.
35. Partridge JSL, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing. 2012 Mar;41(2):142–7.
36. Goeteyn J, Evans LA, De Cleyn S, Fauconnier S, Damen C, Hewitt J, et al. Frailty as a predictor of mortality in the elderly emergency general surgery patient. Acta Chir Belg. 2017 Jun 10;1–6.
37. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001 Mar;56(3):M146-156.
38. Hewitt J, Moug SJ, Middleton M, Chakrabarti M, Stechman MJ, McCarthy K, et al. Prevalence of frailty and its association with mortality in general surgery. Am J Surg. 2015 Feb;209(2):254–9.
39. Abellan van Kan G, Rolland YM, Morley JE, Vellas B. Frailty: toward a clinical definition. J Am Med Dir Assoc. 2008 Feb;9(2):71–2.
40. Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008 Jan;12(1):29–37.
Citation tools
Eguaras Córdoba I, Herrera Cabezón J, Sánchez Acedo P, Galbete Jiménez A, Guillén Grima F. The Urgent Surgery Elderly Mortality risk score: a simple mortality score. 6187/2019


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1210 visits.
This article has been downloaded 185 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 21/01/2019

Accepted: 07/03/2019

Online First: 18/07/2019

Published: 05/09/2019

Article revision time: 38 days

Article Online First time: 178 days

Article editing time: 227 days


Share
This article has been rated by 2 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2024 y Creative Commons. The Spanish Journal of Gastroenterology