Department of Public Health and Social Medicine, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal.
Department of Surgery, Faculty of Health Sciences, Gaston Berger University, Saint-Louis, Senegal.
BMC Surg. 2024 Oct 24;24(1):328. doi: 10.1186/s12893-024-02613-x.
Abdominal surgical emergencies have a high mortality rate. Effective management primarily relies on the early identification of patients at high risk of postoperative complications. The objective of our study was to determine the prognostic factors associated with poor outcomes from abdominal surgical emergencies in Senegal and to establish a predictive score for mortality for preoperative risk evaluation (NDAR (New Death Assessment Risk) score).
This was a retrospective national cross-sectional study conducted over one year in 14 regions of Senegal. Adult patients (aged > 15 years) who presented with a traumatic or non-traumatic abdominal surgical emergency were included. The studied variables included clinical and paraclinical data. The variable of interest was death within 30 days of the surgery. Logistic regression was used to identify the factors independently associated with mortality. Risk factors identified after logistic regression analysis were weighted using odds ratio (OR) values rounded to the nearest whole number. The predictive capacity of the score was evaluated by analyzing the ROC (Receiver Operating Characteristic) curve based on the area under the curve (AUC).
A total of 1114 patient records were included, with a mortality rate of 4.4%. Diagnoses were observed in patients included appendicitis in 39.8% of cases (n = 444), followed by peritonitis in 22.3% (n = 249), intestinal obstruction in 18.5% (n = 205), strangulated hernias in 10.5% (n = 117), and abdominal trauma in 6.1%. Logistic regression, established the following scores: age > 40 years (score 2), ASA status grade 2 or higher (score 1), presence of a positive QSIRS score (score 2), diagnosis of peritonitis (score 2), diagnosis of intestinal obstruction (score 1), and the presence of intestinal necrosis (score 3). The score is positive if the total is strictly greater than 5, indicating a 17.7% risk of mortality. This score had a high predictive capacity with an AUC of 0.7397.
This study enabled the establishment of a score that allows for the early identification of at-risk patients, even in constrained resource settings, facilitating appropriate perioperative management and timely surgical intervention to reduce the risk of complications. This approach, focused on early recognition of high-risk patients, is crucial for improving clinical outcomes in abdominal surgical emergencies.
腹部外科急症的死亡率较高。有效的管理主要依赖于早期识别术后并发症高危患者。我们的研究目的是确定与塞内加尔腹部外科急症不良预后相关的预测因素，并建立术前风险评估的死亡率预测评分（NDAR（新死亡评估风险）评分）。
这是一项在塞内加尔 14 个地区进行的为期一年的回顾性全国性横断面研究。纳入了有创伤性或非创伤性腹部外科急症的成年患者（年龄>15 岁）。研究变量包括临床和实验室数据。研究变量为术后 30 天内死亡。使用逻辑回归确定与死亡率独立相关的因素。逻辑回归分析后确定的危险因素使用最接近整数的比值比（OR）值进行加权。通过分析基于曲线下面积（AUC）的 ROC（接收者操作特征）曲线来评估评分的预测能力。
共纳入 1114 例患者病历，死亡率为 4.4%。诊断为阑尾炎占 39.8%（n=444），其次是腹膜炎占 22.3%（n=249）、肠梗阻占 18.5%（n=205）、绞窄性疝占 10.5%（n=117）、腹部创伤占 6.1%。逻辑回归建立了以下评分：年龄>40 岁（评分 2）、ASA 状态 2 级或更高（评分 1）、QSIRS 评分阳性（评分 2）、诊断为腹膜炎（评分 2）、诊断为肠梗阻（评分 1）和肠坏死（评分 3）。如果总分严格大于 5，则表示有 17.7%的死亡风险，则该评分呈阳性。该评分具有较高的预测能力，AUC 为 0.7397。
本研究建立了一种评分，可以早期识别高危患者，即使在资源有限的情况下，也有助于进行适当的围手术期管理和及时手术干预，降低并发症风险。这种方法侧重于早期识别高危患者，对于改善腹部外科急症的临床结局至关重要。
