SP8.2.6 Risk Prediction in Emergency Giant Hiatus and Diaphragmatic Hernia Repairs. (9th August 2022)

• Record Type: Journal Article
• Authors: Alasmar, Mohamed; Moore, Eleanor; McKechnie, Iona; Chaparala, Ram
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 5
• Publication Date: 2022-08-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac247.095
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aims: Emergency presentation of giant hiatus and diaphragmatic hernias are associated with significant morbidity and mortality. The preoperative risk prediction tools not only can 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. We compared the outcomes to the predicted mortality and morbidity of different risk prediction models. The mortality models SORT, NELA and ACS-NSQIP were compared using the area under the curve (AUC). We evaluated morbidity by calculating the comprehensive complication index (CCI). Using Spearman correlation, CCI was compared to P-POSSUM and ACS-NSQIP predicted morbidity. Results: 108 patients were included in the analysis. The 30-day mortality rate was 6.93%. ACS-NSQIP had the highest predictive power for mortality (AUC ¼ 0.845) in comparison to NELA (AUC¼0.809) and SORT (AUC ¼ 0.740). Both ACS-NSQIP and P-POSSUM showed moderate correlation to CCI (rho ¼ 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. Multi-centre prospective studies could be used to validate these findings. ACS-NSQIP may have a role in pre-assessment and consenting emergency giant hiatus and diaphragmatic hernia repairs.