Doda Pallavi, Kerai Sukhyanti, Chauhan Kanika, Manchanda Vineet, Saxena Kirti N, Mishra Anurag
Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi, India.
Indian J Anaesth. 2024 Mar;68(3):231-237. doi: 10.4103/ija.ija_888_23. Epub 2024 Feb 22.
There is paucity of studies on preoperative risk assessment tools in patients undergoing emergency surgery. The present study evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator and American Society of Anesthesiologists (ASA) physical status (PS) classification system in patients undergoing emergency exploratory laparotomy.
This retrospective study included 60 adult patients who underwent emergency exploratory laparotomy for perforation peritonitis. The clinical details, ASA PS classification, laboratory investigations and postoperative course of patients were retrieved from their medical records. Based on these details, APACHE II and ACS-NSQIP were calculated for the patients. The study's primary outcome was the accuracy of the preoperative APACHE II, ACS-NSQIP risk calculator and ASA PS class in predicting the postoperative 30-day mortality of patients.
The area under the curve (AUC) of APACHE II, ACS-NSQIP score, and ASA PS classification for mortality 30 days after surgery was 0.737, 0.694 and 0.601, respectively. The value for the Hosmer-Lemeshow (H-L) test of scoring systems was 0.05, 0.25 and 0.05, respectively. AUC for postoperative complications was 0.799 for APACHE II, 0.683 for ACS-NSQIP and 0.601 for ASA PS classification. H-L test of these scoring systems for complications after surgery revealed values of 0.62, 0.36 and 0.53, respectively.
Compared to the ACS-NSQIP and ASA PS classification system, the APACHE II score has a better discriminative ability for postoperative complications and mortality in adult patients undergoing emergency exploratory laparotomy.
关于急诊手术患者术前风险评估工具的研究较少。本研究评估了急性生理与慢性健康状况评估（APACHE）II、美国外科医师学会国家外科质量改进计划（ACS-NSQIP）手术风险计算器以及美国麻醉医师协会（ASA）身体状况（PS）分类系统在急诊剖腹探查术患者中的表现。
这项回顾性研究纳入了60例因穿孔性腹膜炎接受急诊剖腹探查术的成年患者。从他们的病历中获取患者的临床细节、ASA PS分类、实验室检查结果及术后病程。基于这些细节，为患者计算APACHE II和ACS-NSQIP评分。本研究的主要结局是术前APACHE II、ACS-NSQIP风险计算器及ASA PS分级预测患者术后30天死亡率的准确性。
术后30天死亡率的APACHE II、ACS-NSQIP评分及ASA PS分类的曲线下面积（AUC）分别为0.737、0.694和0.601。评分系统的Hosmer-Lemeshow（H-L）检验值分别为0.05、0.25和0.05。术后并发症的AUC，APACHE II为0.799，ACS-NSQIP为0.683，ASA PS分类为0.601。这些评分系统对术后并发症的H-L检验值分别为0.62、0.36和0.53。
与ACS-NSQIP和ASA PS分类系统相比，APACHE II评分对接受急诊剖腹探查术的成年患者术后并发症和死亡率具有更好的鉴别能力。
