Development and internal validation of a clinical prediction model for serious complications after emergency laparotomy.

Complications Laparotomy Prediction Prognosis Validation

Journal

European journal of trauma and emergency surgery : official publication of the European Trauma Society

ISSN: 1863-9941

Titre abrégé: Eur J Trauma Emerg Surg

Pays: Germany

ID NLM: 101313350

Informations de publication

Date de publication:
31 Aug 2023

Historique:

received: 19 05 2023

accepted: 17 08 2023

medline: 31 8 2023

pubmed: 31 8 2023

entrez: 30 8 2023

Statut: aheadofprint

Résumé

Emergency laparotomy (EL) is a common operation with high risk for postoperative complications, thereby requiring accurate risk stratification to manage vulnerable patients optimally. We developed and internally validated a predictive model of serious complications after EL. Data for eleven carefully selected candidate predictors of 30-day postoperative complications (Clavien-Dindo grade > = 3) were extracted from the HELAS cohort of EL patients in 11 centres in Greece and Cyprus. Logistic regression with Least Absolute Shrinkage and Selection Operator (LASSO) was applied for model development. Discrimination and calibration measures were estimated and clinical utility was explored with decision curve analysis (DCA). Reproducibility and heterogeneity were examined with Bootstrap-based internal validation and Internal-External Cross-Validation. The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) model was applied to the same cohort to establish a benchmark for the new model. From data on 633 eligible patients (175 complication events), the SErious complications After Laparotomy (SEAL) model was developed with 6 predictors (preoperative albumin, blood urea nitrogen, American Society of Anaesthesiology score, sepsis or septic shock, dependent functional status, and ascites). SEAL had good discriminative ability (optimism-corrected c-statistic: 0.80, 95% confidence interval [CI] 0.79-0.81), calibration (optimism-corrected calibration slope: 1.01, 95% CI 0.99-1.03) and overall fit (scaled Brier score: 25.1%, 95% CI 24.1-26.1%). SEAL compared favourably with ACS-NSQIP in all metrics, including DCA across multiple risk thresholds. SEAL is a simple and promising model for individualized risk predictions of serious complications after EL. Future external validations should appraise SEAL's transportability across diverse settings.

Identifiants

DOI: 10.1007/s00068-023-02351-4 PMID: 37648805

pubmed: 37648805

doi: 10.1007/s00068-023-02351-4

pii: 10.1007/s00068-023-02351-4

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Références

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