Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
ANZ J Surg. 2023 Jul-Aug;93(7-8):1811-1816. doi: 10.1111/ans.18551. Epub 2023 May 30.
Risk assessment for emergency laparotomy (EL) is important for guiding decision-making and anticipating the level of perioperative care in acute clinical settings. While established tools such as the American College of Surgeons National Surgical Quality Improvement Program calculator (ACS-NSQIP), the National Emergency Laparotomy Audit Risk Prediction Calculator (NELA) and the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity calculation (P-POSSUM) are accurate predictors for mortality, there has been increasing recognition of the benefits from including measurements for frailty in a simple and quantifiable manner. Psoas muscle to 3rd lumbar vertebra area ratio (PM:L3) measured on CT scans was proven to have a significant inverse association with 30-, 90- and 365-day mortality in EL patients.
A retrospective analysis was conducted of 500 patients admitted to four Australian hospitals who underwent EL during 2016-2017, and had contemporaneous abdomino-pelvic CT scans. Radiological sarcopenia was measured as PM:L3 ratios. ASC-NSQIP, NELA and P-POSSUM were retrospectively calculated. Univariate and multivariate logistic regression modelling was used to assess these ratios and scores, as well as American Society of Anaesthesiologists (ASA) classification separated into ASA I-III and IV/V (simplified ASA), as potential predictors of 30-, 90- and 365-day mortality.
PM:L3, simplified ASA, ACS-NSQIP, NELA and P-POSSUM were each statistically significant predictors of 30-day, 90-day and 365-day mortality (P < 0.001). Logistic regression models of 30-, 90- and 365-day mortality combining PM:L3 (P = 0.001) and simplified ASA (P < 0.001) exhibited AUCs of 0.838 (0.780, 0.896), 0.805 (0.751, 0.860) and 0.775 (0.729, 0.822), respectively, which were comparable to that of ACS-NSQIP and NELA.
Combining the semi-physiological parameter ASA classification with PM:L3 provides a quick and simple alternative to the more complex established risk assessment scores and is superior to PM:L3 alone.
对于指导决策和预测急性临床环境中围手术期护理水平，对急诊剖腹手术（EL）进行风险评估非常重要。虽然美国外科医师学院国家外科质量改进计划计算器（ACS-NSQIP）、国家紧急剖腹手术审计风险预测计算器（NELA）和朴茨茅斯生理和手术严重程度评分用于死亡率和发病率计数（P-POSSUM）等既定工具是死亡率的准确预测指标，但越来越多的人认识到以简单和可量化的方式纳入脆弱性测量的好处。在接受 EL 的患者中，CT 扫描上测量的腰大肌到第 3 腰椎区域比（PM:L3）与 30、90 和 365 天死亡率呈显著负相关。
对 2016-2017 年期间在澳大利亚四家医院接受 EL 治疗且同时进行了腹盆部 CT 扫描的 500 名患者进行了回顾性分析。放射学肌少症的测量指标为 PM:L3 比值。回顾性计算 ACS-NSQIP、NELA 和 P-POSSUM。使用单变量和多变量逻辑回归模型评估这些比值和评分，以及美国麻醉师协会（ASA）分类，分为 ASA I-III 和 IV/V（简化 ASA），作为 30、90 和 365 天死亡率的潜在预测因素。
PM:L3、简化 ASA、ACS-NSQIP、NELA 和 P-POSSUM 均为 30 天、90 天和 365 天死亡率的统计学显著预测指标（P < 0.001）。结合 PM:L3（P = 0.001）和简化 ASA（P < 0.001）的 30、90 和 365 天死亡率的逻辑回归模型的 AUC 分别为 0.838（0.780、0.896）、0.805（0.751、0.860）和 0.775（0.729、0.822），与 ACS-NSQIP 和 NELA 相当。
将半生理参数 ASA 分类与 PM:L3 相结合，提供了一种比更复杂的既定风险评估评分更快捷、简单的替代方案，并且优于 PM:L3 单独使用。
