Comparative Analysis of Scoring Systems for Predicting Morbidity and Mortality in Emergency Laparotomy

Area of Science:

• Surgical outcomes research
• Clinical risk stratification
• Emergency medicine

Background:

• Emergency laparotomy carries significant risks of morbidity and mortality.
• Several tools exist for risk stratification, including NELA, P-POSSUM, ACS-NSQIP, and the Hajibandeh Index.
• Comparative analysis of these tools is crucial for optimizing patient care.

Purpose of the Study:

• To compare the predictive accuracy of NELA, P-POSSUM, ACS-NSQIP, and Hajibandeh Index.
• To evaluate the performance of these scoring systems in predicting mortality and key postoperative morbidities following emergency laparotomy.

Main Methods:

• A prospective observational study included 510 patients undergoing emergency laparotomy.
• Preoperative risk assessment was performed using NELA, P-POSSUM, ACS-NSQIP, and Hajibandeh Index.
• Outcomes assessed included 30-day mortality, surgical site infection, anastomotic leak, and re-exploration, with diagnostic accuracy evaluated.

Main Results:

• The NELA score demonstrated the highest predictive accuracy for 30-day mortality (C-statistic: 0.979).
• The Hajibandeh Index showed the highest sensitivity for predicting surgical site infection (C-statistic: 0.760) and anastomotic leakage (C-statistic: 0.741).
• P-POSSUM exhibited the greatest specificity for predicting re-exploration.

Conclusions:

• The NELA score is the most reliable predictor of mortality in emergency laparotomy.
• The Hajibandeh Index is effective for predicting postoperative morbidities like SSI and anastomotic leaks.
• P-POSSUM offers superior specificity for re-exploration risk, suggesting combined use of these tools can enhance patient risk assessment and outcomes.