526 Combining Sarcopenia and ASA Status to Inform Emergency Laparotomy Outcomes: Could It Be That Simple?
J Karolewski, Y J Ming, P Howley, M Holmes, J Gani, P Pockney- Surgery
Abstract
Aim
Emergency laparotomy mortality prediction tools are usually complex multipoint scoring systems. Our aim was to assess a 2 point system comprising radiological sarcopenia plus simplified ASA (PM;L3/sASA) as a potential predictor of 30-, 90- and 365- day mortality in Emergency Laparotomy patients, and compare this to current widely used tools such as NELA, P-Possum and ACS-NSQIP.
Method
A retrospective analysis was conducted across four hospitals, identifying 500 patients who underwent emergency laparotomies between 2016-2017 and had contemporaneous abdomino-pelvic CT scans. Radiological sarcopenia was measured using the PM:L3 ratio on a cross-sectional axial CT slice. PM:L3, NELA, ACS-NSQIP, and P-POSSUM, as well as simplified ASA (sASA) were retrospectively calculated and assessed as potential predictors of 30-, 90-, and 365-day mortality.
Results
ACS-NSQIP, NELA, P-POSSUM and PM:L3/sASA were each statistically significant predictors of 30-day, 90-day and 365-day mortality (p<0.001). Logistic regression models of 30-, 90- and 365-day mortality containing just the two predictors PM:L3 and simplified ASA exhibited AUCs of 0.838, 0.805 and 0.775 respectively, which are comparable with the best currently used predictors ACS-NSQIP and NELA.
Conclusions
Combining PM:L3 with ASA scores appears to be a significant predictor of 30-, 90-, and 365-day mortality in emergency laparotomy patients in Australia. The results are comparable with some of the best performing widely used risk assessment tools and provide a more time-efficient and accessible method of performing risk assessments in Emergency Laparotomy patients.