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Int J Surg. 2018 Dec;60:236-244. doi: 10.1016/j.ijsu.2018.11.023. Epub 2018 Nov 24.

A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: A prospective multi-center study.

Author information

1
Institute of Applied Health Sciences, University of Aberdeen & Aberdeen Royal Infirmary, NHS Grampian, United Kingdom.
2
Department of General Surgery, King's College London, United Kingdom.
3
Department of Biostatistics and Health Informatics, Institute of Psychology Psychiatry and Neuroscience, King's College London, United Kingdom.
4
Department of General Surgery, Manchester Royal Infirmary, United Kingdom.
5
Department of General Surgery, University Hospital of Wales, United Kingdom.
6
Department of General Surgery, Royal Alexandra Hospital, Paisley, United Kingdom.
7
Department of GI Surgery, University Hospital, Ghent, Belgium.
8
Department of Population Medicine, Cardiff University, United Kingdom.
9
Institute of Applied Health Sciences, University of Aberdeen & Aberdeen Royal Infirmary, NHS Grampian, United Kingdom. Electronic address: phyo.myint@abdn.ac.uk.

Abstract

BACKGROUND:

Low albumin is a prognostic factor associated with poor surgical outcomes. We aimed to examine the predicative ability of easily obtainable point-of-care variables in combination, to derive a practical risk scale for predicting older adults at risk of poor outcomes on admission to the emergency general surgical setting.

METHODS:

This is an international multi-center prospective cohort study conducted as part of the Older Persons Surgical Outcomes Collaboration (www.OPSOC.eu). The effect of having hypoalbuminemia (defined as albumin ≤3.5 g/dL) on selected outcomes was examined using fully adjusted multivariable models. In a subgroup of patients with hypoalbuminemia, we observed four risk characteristics (Male, Anemia, Low albumin, Eighty-five and over [MALE]). Subsequently, the impact of incremental increase in MALE score (each characteristic scoring 1 point (maximum score 4) on measured outcomes was assessed.

RESULTS:

The cohort consisted of 1406 older patients with median (IQR) age of 76 (70-83) years. In fully adjusted models, hypoalbuminemia was significantly associated with undergoing emergency surgery (1.32 (95%CI 1.03-1.70); p = 0.03), 30-day mortality (4.23 (2.22-8.08); p < 0.001), 90-day mortality (3.36 (2.14-5.28); p < 0.001) (primary outcome), and increased hospital length of stay, irrespective of whether a patient received emergency surgical intervention. Every point increase in MALE score was associated with higher odds of mortality, with a MALE score of 4 being associated with 30-day mortality (adjusted OR(95% CI) = 33.38 (3.86-288.7); p = 0.001) and 90-day mortality (11.37 (3.85-33.59); p < 0.001) compared to the reference category of those with MALE score 0.

CONCLUSIONS:

The easy to use and practical MALE risk score calculated at point of care identifies older adults at a greater risk of poor outcomes, thereby allowing clinicians to prioritize patients who may benefit from early comprehensive geriatric assessment in the emergency general surgical setting.

KEYWORDS:

Emergency surgical admissions; Hypoalbuminemia; Increased length of hospital stay; Mortality; Older adults; Prognosis

PMID:
30481611
DOI:
10.1016/j.ijsu.2018.11.023

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