Evaluation of Surgical Risk Prediction Tools.

A Multicenter Comparison of Risk Prediction Tools for Emergency Laparotomy in Greece

Introduction: In modern surgery, the prediction of perioperative death gains significant importance due to the availability of treatment options, means of improving the surgical outcome and for proper patient information. However, patient heterogeneity and the existence of multiple risk prediction tools complicate the prediction of perioperative mortality. Thus, prognostic tools are developed based on the analysis of preoperative variables. Most commonly used models are POSSUM, ACS-NSQIP, NELA and POTTER. The models have been assessed in West-European and North-American populations, each with different prognostic value.

Aim: Comparative analysis of predictive accuracy of the aforementioned risk prediction tools in Greek population.

Materials and Methods: The study is multicenter, non-interventional, prospective and observational and includes patients undergoing emergency laparotomies of general surgery. In cases of multiple operations in one hospitalization, the first operation is included. The clinical-laboratory variables, derived from POSSUM, NELA, ACS-NSQIP and POTTER models are recorded anonymously in a secure online database, REDCap (Research Electronic Data Capture).The minimum estimated number of included patients in order to accomplish statistically significant results is 600. Each of the centers submitted in the study, is expected to include approximately 60 patients in a period of 6-12 months. For the statistical analysis of data, Brier Score will be used and ROC with statistical significance lower than 0.05.

Conclusions: Upon completion of this study, the most accurate perioperative risk prediction tool in the Greek population is expected to be proposed.

Study Overview

• Status: Completed
• Conditions: Emergency Laparotomy

• Study Type: Observational
• Enrollment (Actual): 660

Contacts and Locations

Study Locations

• Greece
  • Heraklion, Greece, 71110
    • Department of Surgery, University Hospital of Heraklion

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients admitted in a surgical department during a 12-month study period (May 1, 2020 - May 1, 2021 ).

Description

Inclusion Criteria:

• Age >18yrs
• Emergency laparotomy (operation simultaneously with resuscitation usually within one hour) or urgent (operation as soon as possible after resuscitation, within 24hrs)
• Operation in the gastrointestinal tract:
• Open or laparoscopic, or laparoscopically assisted procedures.
• Procedures involving the stomach, small or large bowel, or rectum for conditions such as perforation, ischaemia, abdominal abscess, bleeding or obstruction
• Wash out/evacuation of intraperitoneal abscess or haematoma
• Bowel resection/repair due to incarcerated/incisional hernias
• Bowel resection or repair due to incarcerated umbilical, inguinal or femoral hernias
• Open or laparoscopic adhesiolysis
• Laparotomy/laparoscopy with inoperable pathology
• Return to theatre for repair of a substantial dehiscence of major abdominal wound (i.e. "burst abdomen")
• Return to theatre after any operation (including vascular, gynecology, urology, cardiac) meeting the criteria above
• In the case of multiple procedures in the abdominopelvic cavity the patient is included if the main procedure is a general surgical one (i.e. if bowel resection happens during an open aneurysm repair it should not be included)
• Any intra-abdominal procedure not identifiable within exclusion criteria should be included.

Exclusion Criteria:

• Patients under 18
• Elective operation
• Diagnostic laparoscopy or laparotomy where no other procedure is performed (NB, if no procedure is performed due to inoperable pathology, then include)
• Appendicectomy with or without drainage of localized abscess
• Cholecystectomy with or without drainage of localized abscess
• Hernia repair without bowel resection
• Minor abdominal wound revision
• Vascular surgery
• Gynecological surgery - c-section - ruptured ectopic pregnancy
• Surgery relating to organ transplantation
• Removal of dialysis catheters

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of deaths within 30 days from emergency laparotomy	Patients who died of any cause within 30 days from emergency laparotomy	30 days after emergency laparotomy

Collaborators and Investigators

• Sponsor: University Hospital of Crete
• Collaborators: Nicosia General Hospital; Evangelismos Hospital; Laikο General Hospital, Athens; Attikon University General Hospital, Athens; Trikala General Hospital, Trikala; Ippokrateio General Hospital of Thessaloniki; General Hospital of Volos; General University Hospital of Patras; University Hospital, Ioannina
• Investigators: Principal Investigator: Konstantinos Lasithiotakis, University Hospital of Heraklion

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2020
• Primary Completion (Actual): August 1, 2021
• Study Completion (Actual): August 1, 2021

Study Registration Dates

• First Submitted: October 28, 2020
• First Submitted That Met QC Criteria: November 3, 2020
• First Posted (Actual): November 4, 2020

Study Record Updates

• Last Update Posted (Actual): December 28, 2021
• Last Update Submitted That Met QC Criteria: December 26, 2021
• Last Verified: December 1, 2021

More Information

Terms related to this study

• Keywords: risk prediction; emergency laparotomy; postoperative mortality; NELA; ACS-risk calculator; POSSUM
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 1681/26-02-2020

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: No there is no plan to make IPD available to other researchers.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No