Department of General Surgery, Faculty of Medicine, Menoufia University, Shebin-Elkom, Menoufia, Egypt.
Laparoscopic Colorectal Surgery Fellow, Swansea Bay University Health Board, Swansea, UK.
BMC Surg. 2023 Sep 21;23(1):286. doi: 10.1186/s12893-023-02189-y.
The Portsmouth-Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) is one of the scores that is used most frequently for determining the likelihood of mortality in patients undergoing emergency laparotomy. National Emergency Laparotomy Audit (NELA) presents a novel and validated score. Therefore, we aimed to compare the performance of the NELA and P-POSSUM mortality risk scores in predicting 30-day and 90-day mortality in patients undergoing emergency laparotomy.
Between August 2020 and October 2022, this cohort study was undertaken at Menoufia University Hospital. We compared the P-POSSUM, preoperative NELA, and postoperative NELA scores in patients undergoing emergency laparotomy. All variables needed to calculate the used scores were collected. The outcomes included the death rates at 30 and 90 days. By calculating the area under the curve (AUC) for every mortality instrument, the discrimination of the various methods was evaluated and compared.
Data from 670 patients were included. The observed risk of 30-day and 90-day mortality was 10.3% (69/670) and 13.13% (88/670), respectively. Concerning 30-day mortality, the AUC was 0.774 for the preoperative NELA score, 0.763 for the preoperative P-POSSUM score, and 0.780 for the postoperative NELA score. Regarding 90-day mortality, the AUCs for the preoperative NELA score, preoperative P-POSSUM score, and postoperative NELA score were 0.649 (0.581-0.717), 0.782 (0.737-0.828), and 0.663 (0.608-0.718), respectively. There was noticeable difference in the three models' capacity for discrimination, according to pairwise comparisons.
The probability of 30-day and 90-day death across the entire population was underestimated by the NELA and P-POSSUM scores. There was discernible difference in predictive performance between the two scores.
朴茨茅斯生理和手术严重程度评分用于死亡率和发病率的枚举（P-POSSUM）是用于确定接受急诊剖腹术患者死亡可能性的最常用评分之一。国家急诊剖腹术审计（NELA）提出了一种新的验证评分。因此，我们旨在比较 NELA 和 P-POSSUM 死亡率风险评分在预测接受急诊剖腹术患者 30 天和 90 天死亡率方面的性能。
本队列研究于 2020 年 8 月至 2022 年 10 月在 Menoufia 大学医院进行。我们比较了接受急诊剖腹术患者的 P-POSSUM、术前 NELA 和术后 NELA 评分。收集了计算使用评分所需的所有变量。结果包括 30 天和 90 天的死亡率。通过计算每个死亡率工具的曲线下面积（AUC），评估和比较了各种方法的区分能力。
纳入了 670 名患者的数据。观察到 30 天和 90 天死亡率的风险分别为 10.3%（69/670）和 13.13%（88/670）。关于 30 天死亡率，术前 NELA 评分的 AUC 为 0.774，术前 P-POSSUM 评分的 AUC 为 0.763，术后 NELA 评分的 AUC 为 0.780。关于 90 天死亡率，术前 NELA 评分、术前 P-POSSUM 评分和术后 NELA 评分的 AUC 分别为 0.649（0.581-0.717）、0.782（0.737-0.828）和 0.663（0.608-0.718）。根据两两比较，三个模型的区分能力存在明显差异。
NELA 和 P-POSSUM 评分低估了整个人群 30 天和 90 天死亡的概率。两种评分在预测性能方面存在明显差异。
