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Published on: September 16, 2022
Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review
C M Oliver1, E Walker2, S Giannaris3
1UCL/UCLH Surgical Outcome Research Centre (SOuRCe), 3rd Floor, Maples Link Corridor, University College Hospital, 235 Euston Road, London NW1 2BU, UK National Institute of Academic Anaesthesia Health Services Research Centre, Royal College of Anaesthetists, London, UK Centre for Anaesthesia, University College London, London, UK cmoliver@hotmail.co.uk.
Identifying high-risk patients for emergency laparotomy is crucial. The APACHE II tool shows consistent outcome discrimination, offering a practical method for perioperative risk assessment and improved patient management.
Area of Science:
- Surgical Outcomes Research
- Critical Care Medicine
- Health Services Research
Background:
- Emergency laparotomies have high mortality rates (1 in 6 patients die within a month).
- Individualized perioperative care is key to reducing morbidity and mortality.
- Current risk assessment tools lack demonstrated practicality and reliability for diverse patient presentations.
Purpose of the Study:
- To systematically review and assess the performance of risk assessment tools for patients undergoing emergency laparotomy.
- To identify reliable methods for individual risk assessment in this high-risk surgical population.
Main Methods:
- Systematic review of Embase and Medline databases.
- Inclusion of 20 validation studies assessing 25 risk assessment tools.
- Analysis focused on tool performance, discrimination, and calibration.
Main Results:
- APACHE II, ASA-PS, and P-POSSUM were frequently studied general tools.
- Quantitative comparison was limited by study heterogeneity and poor reporting.
- APACHE II demonstrated consistent outcome discrimination (AUC 0.76-0.98) pre- and postoperatively.
Conclusions:
- APACHE II shows potential for improving shared decision-making, triage, and perioperative management due to its objective, preoperative data.
- Future work should recalibrate APACHE II and P-POSSUM in current patient groups.
- Further research should explore modifications for morbidity prediction and the clinical impact of tool adoption.
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