Development and internal validation of a clinical prediction model for serious complications after emergency laparotomy.

Autor: Kokkinakis S; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece., Kritsotakis EI; Laboratory of Biostatistics, School of Medicine, University of Crete, 71003, Heraklion, Crete, Greece. e.kritsotakis@uoc.gr., Paterakis K; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece., Karali GA; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece., Malikides V; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece., Kyprianou A; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece., Papalexandraki M; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece., Anastasiadis CS; Department of Surgical Oncology, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece., Zoras O; Department of Surgical Oncology, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece., Drakos N; Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece., Kehagias I; Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece., Kehagias D; Department of Surgery, School of Medicine, University General Hospital of Patras, University of Patras, Patras, Greece., Gouvas N; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Kokkinos G; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Pozotou I; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Papatheodorou P; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Frantzeskou K; Department of Surgery, School of Medicine, General Hospital of Nicosia, University of Cyprus, Nicosia, Cyprus., Schizas D; First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece., Syllaios A; First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece., Palios IM; Second Propaedeutic Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece., Nastos K; Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece., Perdikaris M; Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece., Michalopoulos NV; Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece., Margaris I; Department of Surgery, School of Medicine, University General Hospital Attikon, University of Athens, Athens, Greece., Lolis E; Department of Surgery, General Hospital of Volos, Volos, Greece., Dimopoulou G; Department of Surgery, General Hospital of Volos, Volos, Greece., Panagiotou D; Department of Surgery, General Hospital of Trikala, Trikala, Greece., Nikolaou V; Department of Surgery, General Hospital of Trikala, Trikala, Greece., Glantzounis GK; Department of Surgery, University Hospital of Ioannina, Ioannina, Greece., Pappas-Gogos G; Department of Surgery, University Hospital of Ioannina, Ioannina, Greece., Tepelenis K; Department of Surgery, University Hospital of Ioannina, Ioannina, Greece., Zacharioudakis G; Department of Surgery, School of Medicine, Ippokrateion General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece., Tsaramanidis S; Department of Surgery, School of Medicine, Ippokrateion General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece., Patsarikas I; Department of Surgery, School of Medicine, Ippokrateion General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece., Stylianidis G; Second Department of Surgery, Evangelismos General Hospital, Athens, Greece., Giannos G; Second Department of Surgery, Evangelismos General Hospital, Athens, Greece., Karanikas M; Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece., Kofina K; Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece., Markou M; Department of Surgery, School of Medicine, University General Hospital of Alexandroupolis, University of Thrace, Alexandroupolis, Greece., Chrysos E; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece., Lasithiotakis K; Department of General Surgery, School of Medicine, University Hospital of Heraklion, University of Crete, Heraklion, Greece.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2024 Feb; Vol. 50 (1), pp. 283-293. Date of Electronic Publication: 2023 Aug 31.
DOI: 10.1007/s00068-023-02351-4
Abstrakt: 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.
(© 2023. The Author(s).)
Databáze: MEDLINE
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