Abstract
Purpose
Post-operative complications following emergency abdominal surgery are associated with significant morbidity and mortality. Despite the knowledge of prognostic factors associated with poor surgical outcomes; few have described risks of poor outcomes based on admission information in acute surgical setting. We aimed to derive a simple, point-of-care risk scale that predicts adults with increased risk of poor outcomes.
Methods
We used data from an international multi-centre prospective cohort study. The effect of characteristics; age, hypoalbuminaemia, anaemia, renal insufficiency and polypharmacy on 90-day mortality was examined using fully adjusted multivariable models. For our secondary outcome we aimed to test whether these characteristics could be combined to predict poor outcomes in adults undergoing emergency general surgery. Subsequently, the impact of incremental increase in derived SHARP score on outcomes was assessed.
Results
The cohort consisted of 419 adult patients between the ages of 16–94 years (median 52; IQR(39) consecutively admitted to five emergency general surgical units across the United Kingdom and one in Ghent, Belgium. In fully adjusted models the aforementioned characteristics; were associated with 90-day mortality. SHARP score was associated with higher odds of mortality in adults who underwent emergency general surgery, with a SHARP score of five also being associated with an increased length of hospital stay.
Conclusions
SHARP risk score is a simple prognostic tool, using point-of-care information to predict poor outcomes in patients undergoing emergency general surgery. This information may be used to improve management plans and aid clinicians in delivering more person-centred care. Further validation studies are required to prove its utility.
Post-operative complications following emergency abdominal surgery are associated with significant morbidity and mortality. Despite the knowledge of prognostic factors associated with poor surgical outcomes; few have described risks of poor outcomes based on admission information in acute surgical setting. We aimed to derive a simple, point-of-care risk scale that predicts adults with increased risk of poor outcomes.
Methods
We used data from an international multi-centre prospective cohort study. The effect of characteristics; age, hypoalbuminaemia, anaemia, renal insufficiency and polypharmacy on 90-day mortality was examined using fully adjusted multivariable models. For our secondary outcome we aimed to test whether these characteristics could be combined to predict poor outcomes in adults undergoing emergency general surgery. Subsequently, the impact of incremental increase in derived SHARP score on outcomes was assessed.
Results
The cohort consisted of 419 adult patients between the ages of 16–94 years (median 52; IQR(39) consecutively admitted to five emergency general surgical units across the United Kingdom and one in Ghent, Belgium. In fully adjusted models the aforementioned characteristics; were associated with 90-day mortality. SHARP score was associated with higher odds of mortality in adults who underwent emergency general surgery, with a SHARP score of five also being associated with an increased length of hospital stay.
Conclusions
SHARP risk score is a simple prognostic tool, using point-of-care information to predict poor outcomes in patients undergoing emergency general surgery. This information may be used to improve management plans and aid clinicians in delivering more person-centred care. Further validation studies are required to prove its utility.
| Original language | English |
|---|---|
| Pages (from-to) | 2668-2674 |
| Number of pages | 7 |
| Journal | Asian Journal of Surgery |
| Volume | 46 |
| Issue number | 7 |
| Early online date | 5 Nov 2022 |
| DOIs | |
| Publication status | Published - Jul 2023 |
Bibliographical note
AcknowledgementsCardiff and Vale University Health Board: Maeve Middleton, Silas Fuller, Siti Abdul Jabar, Stephanie Thomas, Mathew Williams, Amy Black, Svetlana Kulikouskaya, Caroline Best, Andrew Forrester, Joseph Ereaut, James Moore, Dominic Hampson, Stephanie Owen, Shaanjan Islam, Nicolas Gill, Stephan Merrix, Jack Topham, Pip Killingworth, Syed Rahman and Nurulaida Mohd Darus.
North Bristol NHS Trust: Madeline Tarant, Emily Benson, Tom Wright, Sarah Blake, Calum Honeyman, Simon Huf, Anni Dong, Indira Garaeva, Manuk Wijeyaratne, Michael Campbell and Eng Hean Teh.
Principal Investigators of OPSOC: Susan Moug.
Royal Alexandra Hospital: Mahua Chakrabati, Adam Tay and Nurwasimah Haj Asnan.
NHS Grampian: Caroline McCormack, Hui Sian Tay, Matthew Greig, Vincent Quan.
Central Manchester University Hospitals: Jen Law and Elizabeth Norris.
Ghent University Hospital: J Goeteyn.
Funding resources
Panayiotis Tanos received summer research scholarship from Innes Will Endowment funds as part of the Aberdeen Clinical Academic Training (ACAT) Scheme.
Keywords
- Emergency general surgery
- frailty
- prospective cohort study
- polypharmacy
- anaemia
- elderly
- renal impairment