P-EGS17 Evaluation of Different Surgical Risk Prediction Models in Predicting Morbidity and Mortality in Emergency Giant Hiatus and Diaphragmatic Hernia Repairs. (16th December 2021)

• Record Type: Journal Article
• Authors: Alasmar, Mohamed; Moore, Eleanor; McKechnie, Iona; Chaparala, Ram
• Is Part Of: British journal of surgery. Volume 108:Supplement 9(2021)
• Publication Date: 2021-12-16
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab430.077
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Emergency presentation of giant hiatus and diaphragmatic hernias are associated with significant morbidity and mortality, and predicting perioperative risks can be difficult. There are several preoperative risk evaluation models used commonly in emergency general surgery. Not only can they help clinicians stratify risk, but they can also be valuable tools to outline surgical risks to patients and families. This study aimed to evaluate the suitability of different risk prediction models when predicting morbidity and mortality in emergency giant hiatus and diaphragmatic hernia repairs. Methods: This was a retrospective cohort study of all emergency hiatus and diaphragmatic hernia repairs at a tertiary upper gastrointestinal centre from 2010 to 2021. The outcomes were compared to the predicted mortality and morbidity of different risk prediction models. The mortality models SORT (Surgical Outcome Risk Tool), NELA (National Emergency Laparotomy Audit) and ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Programme) were compared using the area under the curve (AUC). Morbidity was evaluated by calculating the comprehensive complication index (CCI). CCI was compared to P-POSSUM (Portsmouth – Physiological and Operative Severity Score) and ACS-NSQIP predicted morbidity using Spearman correlation. Results: 108 patients were included in the analysis. 49.1% were female, and 50.9% were male. The median age was 69 (IQR 59-78). The 30-day mortality rate was 6.93%. ACS-NSQIP had the highest predictive power for mortality (AUC = 0.845), in comparison to NELA (AUC=0.809) and SORT (AUC = 0.740). Both ACS-NSQIP and P-POSSUM showed moderate correlation to CCI (rho = 0.489, p < 0.001 and 0.446, p < 0.001 respectively). Conclusions: ACS-NSQIP is a better predictor of both mortality and morbidity in emergency giant hiatus and diaphragmatic hernia repairs when compared to NELA, P-POSSUM and SORT. ACS-NSQIP may have a role in pre-assessment and consenting of emergency giant hiatus and diaphragmatic hernia repairs. Multi-centre prospective studies could be used to validate these findings.