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Preoperative assessment of surgical risk: creation of a scoring tool to estimate 1-year mortality after emergency abdominal surgery in the elderly patient

  • Olubode A. Olufajo
    Affiliations
    Division of Trauma, Burn and Surgical Critical Care, Department of Surgery Brigham and Women's Hospital, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA
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  • Gally Reznor
    Affiliations
    Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA
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  • Stuart R. Lipsitz
    Affiliations
    Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA
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  • Zara R. Cooper
    Affiliations
    Division of Trauma, Burn and Surgical Critical Care, Department of Surgery Brigham and Women's Hospital, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA
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  • Adil H. Haider
    Affiliations
    Division of Trauma, Burn and Surgical Critical Care, Department of Surgery Brigham and Women's Hospital, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA
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  • Ali Salim
    Affiliations
    Division of Trauma, Burn and Surgical Critical Care, Department of Surgery Brigham and Women's Hospital, Boston, MA, USA

    Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA, USA
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  • Erika L. Rangel
    Correspondence
    Corresponding author. Tel.: +1-617-983-7212; fax: +1-617-983-7870.
    Affiliations
    Division of Trauma, Burn and Surgical Critical Care, Department of Surgery Brigham and Women's Hospital, Boston, MA, USA
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Published:September 02, 2016DOI:https://doi.org/10.1016/j.amjsurg.2016.08.007

      Highlights

      • Elderly patients are at high risk for poor long-term outcomes after emergency surgery.
      • A scoring tool predicts 1-year mortality in elderly emergency surgery patients.
      • The score uses 5 clinical variables that are part of a standard preoperative workup.
      • Preoperative risk assessment improves the surgeon's ability to counsel patients.
      • Objective estimation of risk empowers patients to partake in decision-making.

      Abstract

      Background

      The risk of mortality after emergency general surgery (EGS) in elderly patients is prolonged beyond initial hospitalization. Our objective was to develop a preoperative scoring tool to quantify risk of 1-year mortality.

      Methods

      Three hundred ninety EGS patients aged 70 years or more were analyzed. Risk factors for 1-year mortality were identified using stepwise-forward logistic multivariate regression and weights assigned using natural logarithm of odds ratios. A geriatric emergency surgery mortality (GEM) score was derived from the aggregate of weighted scores. Leave-one-out cross-validation was performed.

      Results

      One-year mortality was 32%. Risk factors and their weights were: acute kidney injury (2), American Society of Anesthesiology class greater than or equal to 4 (2), Charlson Comorbidity Index greater than or equal to 4 (1), albumin less than 3.5 mg/dL (1), and body mass index (less than 18.5 kg/m2 [1]; 18.5 to 29.9 kg/m2 [0]; ≥30 kg/m2 [−1]). One-year mortality was: GEM 0 to 1 (0% to 7%); GEM 2 to 5 (32% to 68%); GEM 6 to 8 (94% to 100%). C-statistics were .82 and .75 in training and validation data sets, respectively.

      Conclusions

      A simple score using 5 clinical variables predicts 1-year mortality after EGS with reasonable accuracy and assists in preoperative counseling.

      Keywords

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