Key result
Combining radiological sarcopenia and simplified ASA status significantly predicted 30-, 90-, and 365-day mortality following emergency laparotomy with AUCs of 0.838, 0.805, and 0.775 (p<0.001).
Why the study?
Emergency laparotomy mortality prediction tools are usually complex multipoint scoring systems, prompting evaluation of a simpler two-point system combining radiological sarcopenia and simplified ASA.
Does a 2-point system comprising radiological sarcopenia and simplified ASA predict 30-, 90-, and 365-day mortality in emergency laparotomy patients comparably to complex scoring systems?
Observational (n=500)
Yes
Does a 2-point system comprising radiological sarcopenia and simplified ASA predict 30-, 90-, and 365-day mortality in emergency laparotomy patients comparably to complex scoring systems?
Effect estimate: AUC 0.838 for 30-day mortality
p-value: p=<0.001
A simplified 2-point scoring system combining radiological sarcopenia and ASA status predicts mortality in emergency laparotomy patients with accuracy comparable to complex tools like NELA and ACS-NSQIP.
PM;L3/sASA may support mortality risk stratification in emergency laparotomy; leaves open prospective validation versus established scores.
Aim Emergency laparotomy mortality prediction tools are usually complex multipoint scoring systems. Our aim was to assess a 2 point system comprising radiological sarcopenia plus simplified ASA (PM;L3/sASA) as a potential predictor of 30-, 90- and 365- day mortality in Emergency Laparotomy patients, and compare this to current widely used tools such as NELA, P-Possum and ACS-NSQIP. Method A retrospective analysis was conducted across four hospitals, identifying 500 patients who underwent emergency laparotomies between 2016-2017 and had contemporaneous abdomino-pelvic CT scans. Radiological sarcopenia was measured using the PM:L3 ratio on a cross-sectional axial CT slice. PM:L3, NELA, ACS-NSQIP, and P-POSSUM, as well as simplified ASA (sASA) were retrospectively calculated and assessed as potential predictors of 30-, 90-, and 365-day mortality. Results ACS-NSQIP, NELA, P-POSSUM and PM:L3/sASA were each statistically significant predictors of 30-day, 90-day and 365-day mortality (p<0.001). Logistic regression models of 30-, 90- and 365-day mortality containing just the two predictors PM:L3 and simplified ASA exhibited AUCs of 0.838, 0.805 and 0.775 respectively, which are comparable with the best currently used predictors ACS-NSQIP and NELA. Conclusions Combining PM:L3 with ASA scores appears to be a significant predictor of 30-, 90-, and 365-day mortality in emergency laparotomy patients in Australia. The results are comparable with some of the best performing widely used risk assessment tools and provide a more time-efficient and accessible method of performing risk assessments in Emergency Laparotomy patients.
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Karolewski et al. (2023) conducted an observational in Emergency laparotomy (n=500). PM:L3/sASA (radiological sarcopenia plus simplified ASA) vs. NELA, P-POSSUM, and ACS-NSQIP was evaluated on 30-day, 90-day, and 365-day mortality (AUC 0.838 for 30-day mortality, p=<0.001). Combining radiological sarcopenia and simplified ASA status significantly predicted 30-, 90-, and 365-day mortality following emergency laparotomy with AUCs of 0.838, 0.805, and 0.775 (p<0.001).
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