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Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review

Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review
Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review
Emergency laparotomies are performed commonly throughout the world, but one in six patients die within a month of surgery. Current international initiatives to reduce the considerable associated morbidity and mortality are founded upon delivering individualised perioperative care. However, while the identification of high-risk patients requires the routine assessment of individual risk, no method of doing so has been demonstrated to be practical and reliable across the commonly encountered spectrum of presentations, co-morbidities and operative procedures. A systematic review of Embase and Medline identified 20 validation studies assessing 25 risk assessment tools in patients undergoing emergency laparotomy. The most frequently studied general tools were APACHE II, ASA-PS and P-POSSUM. Comparative, quantitative analysis of tool performance was not feasible due to the heterogeneity of study design, poor reporting and infrequent within-study statistical comparison of tool performance. Reporting of calibration was notably absent in many prognostic tool validation studies. APACHE II demonstrated the most consistent discrimination of individual outcome across a variety of patient groups undergoing emergency laparotomy when used either preoperatively or postoperatively (area under the curve 0.76-0.98). While APACHE systems were designed for use in critical care, the ability of APACHE II to generate individual risk estimates from objective, exclusively preoperative data items may lead to better-informed shared decisions, triage and perioperative management of patients undergoing emergency laparotomy. Future endeavours should include the recalibration of APACHE II and P-POSSUM in contemporary cohorts, modifications to enable prediction of morbidity and assessment of the impact of adoption of these tools on clinical practice and patient outcomes.
emergency laparotomy, postoperative mortality, prognostic tool, risk adjustment, risk assessment
0007-0912
Oliver, C.M.
9bd35fec-7026-47bc-966a-efb8b9fd622e
Walker, E.
ef3340fe-5730-4614-a6b9-7652b3984f20
Giannaris, S.
4d2fcfc9-b7ff-4f86-8ebf-d6afc4ee2022
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Moonesinghe, S.R.
2461cb46-56a1-4795-bd9b-0f30e65d6a32
Oliver, C.M.
9bd35fec-7026-47bc-966a-efb8b9fd622e
Walker, E.
ef3340fe-5730-4614-a6b9-7652b3984f20
Giannaris, S.
4d2fcfc9-b7ff-4f86-8ebf-d6afc4ee2022
Grocott, M.P.W.
1e87b741-513e-4a22-be13-0f7bb344e8c2
Moonesinghe, S.R.
2461cb46-56a1-4795-bd9b-0f30e65d6a32

Oliver, C.M., Walker, E., Giannaris, S., Grocott, M.P.W. and Moonesinghe, S.R. (2015) Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review British Journal of Anaesthesia (doi:10.1093/bja/aev350). (PMID:26537629).

Record type: Article

Abstract

Emergency laparotomies are performed commonly throughout the world, but one in six patients die within a month of surgery. Current international initiatives to reduce the considerable associated morbidity and mortality are founded upon delivering individualised perioperative care. However, while the identification of high-risk patients requires the routine assessment of individual risk, no method of doing so has been demonstrated to be practical and reliable across the commonly encountered spectrum of presentations, co-morbidities and operative procedures. A systematic review of Embase and Medline identified 20 validation studies assessing 25 risk assessment tools in patients undergoing emergency laparotomy. The most frequently studied general tools were APACHE II, ASA-PS and P-POSSUM. Comparative, quantitative analysis of tool performance was not feasible due to the heterogeneity of study design, poor reporting and infrequent within-study statistical comparison of tool performance. Reporting of calibration was notably absent in many prognostic tool validation studies. APACHE II demonstrated the most consistent discrimination of individual outcome across a variety of patient groups undergoing emergency laparotomy when used either preoperatively or postoperatively (area under the curve 0.76-0.98). While APACHE systems were designed for use in critical care, the ability of APACHE II to generate individual risk estimates from objective, exclusively preoperative data items may lead to better-informed shared decisions, triage and perioperative management of patients undergoing emergency laparotomy. Future endeavours should include the recalibration of APACHE II and P-POSSUM in contemporary cohorts, modifications to enable prediction of morbidity and assessment of the impact of adoption of these tools on clinical practice and patient outcomes.

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More information

Published date: 3 November 2015
Keywords: emergency laparotomy, postoperative mortality, prognostic tool, risk adjustment, risk assessment
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 384069
URI: http://eprints.soton.ac.uk/id/eprint/384069
ISSN: 0007-0912
PURE UUID: 5acc60d5-ded8-4350-b83b-d7872df2324e

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Date deposited: 09 Dec 2015 16:58
Last modified: 17 Jul 2017 20:08

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Contributors

Author: C.M. Oliver
Author: E. Walker
Author: S. Giannaris
Author: M.P.W. Grocott
Author: S.R. Moonesinghe

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