Key result
Preoperative risk tools accurately predict mortality after emergency laparotomy, led by P-POSSUM and NELA.
Why the study?
Preoperative risk assessment for emergency laparotomy may enhance decision-making regarding urgency or perioperative critical care admission and promote more informed consent.
Do preoperative risk assessment tools accurately predict mortality in patients undergoing emergency laparotomy?
Systematic Review
Do preoperative risk assessment tools accurately predict mortality in patients undergoing emergency laparotomy?
A systematic review of 82 observational studies highlights that while various preoperative risk tools (e.g., P-POSSUM, NELA) generally demonstrate accurate mortality risk prediction in emergency laparotomy, significant study heterogeneity prevents pooled meta-analysis.
Supports use of P-POSSUM, NELA and similar tools for mortality prediction after emergency laparotomy; leaves open definitive confirmation pending standardized prospective studies.
Background: Preoperative assessment of risk for emergency laparotomy may enhance decision making with regards to urgency or perioperative critical care admission and promote a more informed consent process for patients. Accordingly, we aimed to assess the performance of risk assessment tools in predicting mortality after emergency laparotomy. Methods: PubMed, Embase, the Cochrane Library and CINAHL were searched to 12 February 2022 for observational studies reporting expected mortality based on a preoperative risk assessment and actual mortality after emergency laparotomy. Study screening, data extraction, and risk of bias using the Downs and Black checklist were performed in duplicate. Data on setting, operation undertaken, expected and actual mortality rates were extracted. Meta-analysis was planned but not possible due to heterogeneity. This study is registered with PROSPERO, CRD42022299227. Results: From 10,168 records, 82 observational studies were included. 17 risk assessment tools were described, the most common of which were P-POSSUM (42 studies), POSSUM (13 studies), NELA (12 studies) and MPI (11 studies). Articles were published between 1990 and 2022 with the most common country of origin being the UK (33 studies) followed by India (11 studies). Meta-analysis was not possible. Observed mortality and expected mortality based on risk assessment is reported for each study and generally shows most studies show accurate risk prediction. Conclusions: This review synthesises available literature to characterise the performance of various risk assessment tools in predicting mortality after emergency laparotomy. Findings from this study may benefit those undertaking emergency laparotomy and future research in risk prediction.
No takes yet. Share an insight, caveat, or question.
Hewitt et al. (2024) conducted a systematic review in Emergency laparotomy. Preoperative risk assessment tools (e.g., P-POSSUM, NELA, POSSUM, MPI, APACHE) vs. Other risk assessment tools or actual observed mortality was evaluated on Predicted versus actual 30-day or hospital discharge mortality. Preoperative risk assessment tools, most commonly P-POSSUM, POSSUM, NELA, and MPI, generally demonstrated accurate risk prediction for mortality after emergency laparotomy, though meta-analysis was not possible due to study heterogeneity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: