Adding the Clinical Frailty Scale to P-POSSUM and NELA risk models significantly improved discrimination in elderly patients undergoing emergency laparotomy (AUC increased to 0.846 and 0.864; p<0.05).
Cohort
No
Does adding the Clinical Frailty Scale to P-POSSUM and NELA risk prediction tools improve mortality risk prediction in patients undergoing emergency laparotomy?
Adding the Clinical Frailty Scale to standard risk prediction tools significantly improves mortality risk prediction in elderly patients undergoing emergency laparotomy.
Effect estimate: AUC 0.846 (P-POSSUM+CFS) and 0.864 (NELA+CFS)
p-value: p=< 0.05
OBJECTIVE: We set out to assess the performance of the P-POSSUM and NELA risk prediction tool (NELA RPT), and hypothesized that combining them with the Clinical Frailty Scale (CFS) would significantly improve their performance. Emergency laparotomy (EL) is a high-risk surgical intervention, particularly for elderly patients with marked comorbidities and frailty. Accurate risk prediction is crucial for appropriate resource allocation, clinical decision making, and informed consent. Although patient frailty is a significant risk factor, the current risk prediction tools fail to take frailty into account. METHODS: In this retrospective single-center cohort study, we analyzed all cases entered into the NELA database from the Oxford University Hospitals between 01.01.2018 and 15.06.2021. We analyzed the performance of the P-POSSUM and NELA RPT. Both tools were modified by adding the CFS to the model. RESULTS: The discrimination of both the P-POSSUM and NELA RPT was good, with a slightly worse performance in the elderly. Adding CFS into the P-POSSUM and NELA RPT models improved both tools in the elderly [AUC from 0.775 to 0.846 (p 65 years. However, in younger patients, this effect was less marked than in the elderly. CONCLUSION: Our analysis demonstrated a significant improvement in the P-POSSUM and NELA risk models when combined with the CFS. Frailty also increases the 30-day mortality after EL in younger individuals.
Isand et al. (Thu,) conducted a cohort in Emergency laparotomy. Addition of Clinical Frailty Scale (CFS) to risk prediction tools vs. P-POSSUM and NELA risk prediction tools alone was evaluated on Model discrimination (AUC) in elderly patients (AUC 0.846 (P-POSSUM+CFS) and 0.864 (NELA+CFS), p=< 0.05). Adding the Clinical Frailty Scale to P-POSSUM and NELA risk models significantly improved discrimination in elderly patients undergoing emergency laparotomy (AUC increased to 0.846 and 0.864; p<0.05).