Emergency laparotomy preoperative risk assessment tool performance: A systematic review

Area of Science:

• Surgical outcomes research
• Clinical risk prediction modeling
• Perioperative medicine

Background:

• Preoperative risk assessment is crucial for emergency laparotomy decision-making and patient consent.
• Accurate risk prediction can guide urgency and critical care admission decisions.
• Evaluating existing tools is essential for improving patient care.

Purpose of the Study:

• To assess the performance of various risk assessment tools in predicting mortality after emergency laparotomy.
• To synthesize evidence on the accuracy of preoperative risk prediction in this patient population.

Main Methods:

• A systematic review of observational studies was conducted, searching PubMed, Embase, Cochrane Library, and CINAHL up to February 2022.
• Data extraction and risk of bias assessment (Downs and Black checklist) were performed in duplicate.
• 17 distinct risk assessment tools were identified across 82 included studies.

Main Results:

• The most frequently used tools were P-POSSUM (42 studies), POSSUM (13 studies), NELA (12 studies), and MPI (11 studies).
• Studies originated primarily from the UK (33) and India (11), with publications spanning from 1990 to 2022.
• While meta-analysis was not feasible due to heterogeneity, reported data generally indicated accurate risk prediction by most tools.

Conclusions:

• This review synthesizes current literature on the performance of risk assessment tools for emergency laparotomy mortality prediction.
• The findings suggest that existing tools, when applied appropriately, offer generally accurate risk predictions.
• This evidence can inform clinical practice and guide future research in refining perioperative risk stratification.