ACS-NSQIP grading system may predict mortality after Emergency laparotomy: study

Recently published retrospective study, the researchers 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 predicting postoperative 30-day mortality and complications in adult patients undergoing emergency exploratory laparotomy for perforation peritonitis. They included 60 adult patients and retrieved their clinical details, ASA PS classification, laboratory investigations, and postoperative course from their medical records to calculate APACHE II and ACS-NSQIP scores. The study's primary outcome was the accuracy of APACHE II, ACS-NSQIP, and ASA PS class in predicting postoperative 30-day mortality. The results showed that the AUC for predicting mortality for APACHE II, ACS-NSQIP score, and ASA PS classification were 0.737, 0.694, and 0.601 respectively. In addition, the AUC for postoperative complications was 0.799 for APACHE II, 0.683 for ACS-NSQIP, and 0.601 for ASA PS classification. The study concluded that the APACHE II score had a better discriminative ability for postoperative complications and mortality compared to ACS-NSQIP and ASA PS classification system in adult patients undergoing emergency exploratory laparotomy. The findings suggest that for patients undergoing emergency exploratory laparotomy, the APACHE II score may be more effective in predicting postoperative outcomes compared to the ACS-NSQIP surgical risk calculator and ASA PS classification system. However, the study acknowledged some limitations, such as its retrospective nature and the inclusion of a small number of patients.

Overall, the study indicates the potential of the APACHE II score as a valuable tool for preoperative risk assessment in emergency surgery, and it provides valuable insight into the comparative performance of different scoring systems in predicting postoperative mortality and complications in emergency exploratory laparotomy for perforation peritonitis.

Key Points

- The 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 predicting postoperative 30-day mortality and complications in adult patients undergoing emergency exploratory laparotomy for perforation peritonitis.

- Results showed that the APACHE II score had a better discriminative ability for predicting postoperative complications and mortality compared to the ACS-NSQIP and ASA PS classification system in adult patients undergoing emergency exploratory laparotomy, with a higher area under the curve (AUC) for both mortality and complications.

- The study suggests the potential of the APACHE II score as a valuable tool for preoperative risk assessment in emergency surgery and provides valuable insight into the comparative performance of different scoring systems in predicting postoperative mortality and complications in emergency exploratory laparotomy for perforation peritonitis.

Reference –

Doda, Pallavi; Kerai, Sukhyanti; Chauhan, Kanika; Manchanda, Vineet; Saxena, Kirti N.; Mishra, Anurag. Comparison of Acute Physiology and Chronic Health Evaluation (APACHE) II and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) scoring system in predicting postoperative mortality in patients undergoing emergency laparotomy: A retrospective study. Indian Journal of Anaesthesia 68(3):p 231-237, March 2024. | DOI: 10.4103/ija.ija_888_23