Key result
SEAL model outperforms ACS-NSQIP in predicting 30-day serious emergency laparotomy complications with a 0.80 c-statistic.
Why the study?
Emergency laparotomy carries a high risk for postoperative complications, requiring accurate risk stratification to optimally manage vulnerable patients.
Does the SEAL model accurately predict 30-day serious complications after emergency laparotomy compared to the ACS-NSQIP model?
Cohort (n=633)
Yes
Does the SEAL model accurately predict 30-day serious complications after emergency laparotomy compared to the ACS-NSQIP model?
Effect estimate: c-statistic 0.80 (95% CI 0.79-0.81)
The SEAL model is a simple, internally validated tool that accurately predicts serious complications after emergency laparotomy, performing favorably compared to the ACS-NSQIP model.
May aid risk stratification in emergency laparotomy; leaves open external validation before clinical adoption.
PURPOSE: Emergency laparotomy (EL) is a common operation with high risk for postoperative complications, thereby requiring accurate risk stratification to manage vulnerable patients optimally. We developed and internally validated a predictive model of serious complications after EL. METHODS: Data for eleven carefully selected candidate predictors of 30-day postoperative complications (Clavien-Dindo grade > = 3) were extracted from the HELAS cohort of EL patients in 11 centres in Greece and Cyprus. Logistic regression with Least Absolute Shrinkage and Selection Operator (LASSO) was applied for model development. Discrimination and calibration measures were estimated and clinical utility was explored with decision curve analysis (DCA). Reproducibility and heterogeneity were examined with Bootstrap-based internal validation and Internal-External Cross-Validation. The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) model was applied to the same cohort to establish a benchmark for the new model. RESULTS: From data on 633 eligible patients (175 complication events), the SErious complications After Laparotomy (SEAL) model was developed with 6 predictors (preoperative albumin, blood urea nitrogen, American Society of Anaesthesiology score, sepsis or septic shock, dependent functional status, and ascites). SEAL had good discriminative ability (optimism-corrected c-statistic: 0.80, 95% confidence interval [CI] 0.79-0.81), calibration (optimism-corrected calibration slope: 1.01, 95% CI 0.99-1.03) and overall fit (scaled Brier score: 25.1%, 95% CI 24.1-26.1%). SEAL compared favourably with ACS-NSQIP in all metrics, including DCA across multiple risk thresholds. CONCLUSION: SEAL is a simple and promising model for individualized risk predictions of serious complications after EL. Future external validations should appraise SEAL's transportability across diverse settings.
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Kokkinakis et al. (2023) conducted a cohort in Emergency laparotomy (n=633). SEAL prediction model vs. ACS-NSQIP model was evaluated on 30-day postoperative serious complications (Clavien-Dindo grade ≥ 3) (c-statistic 0.80, 95% CI 0.79-0.81). The SEAL prediction model demonstrated good discriminative ability for 30-day serious complications after emergency laparotomy with an optimism-corrected c-statistic of 0.80, outperforming the ACS-NSQIP model.
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