SP 9.11 Correlation of Observed and Predicted 30-Day Mortality Using NELA, ACS-NSQIP and SORT in Romanian Octogenarian and Nonagenarian Emergency Laparotomy Patients: A Multicentre Retrospective Cohort Study

Abstract

Emergency laparotomy (EL) carries a 30-day mortality (30-dm) of 8–18%, exceeding 22% in the elderly. The performance of established perioperative risk prediction models in elderly patients undergoing EL remains uncertain. This study evaluated the correlation between observed 30-day mortality and that predicted by the National-Emergency-Laparotomy-Audit (NELA), the American-College-of-Surgeons-National-Surgical-Quality-Improvement-Program (ACS-NSQIP), and the Surgical-Outcome-Risk-Tool (SORT) in Romanian patients aged ≥80 years. This was a multicentre retrospective cohort study spanning 2 years and included all adults ≥80 undergoing EL at 4 acute care hospitals in North-Eastern Romania. The primary outcome was the correlation between actual 30-dm and NELA, ACS-NSQIP, and SORT-predicted 30-dm in patients aged ≥80 years. The study adhered to the TRIPOD checklist. Statistical analyses were performed using GraphPad Prism v10.6.1. 155 patients were included in the final analysis, representing 19.6% of all EL procedures performed during the study period. Median age was 84 (82,87) years; M/F ratio 0.43; ASA grade 4 (3,4); Clinical-Frailty-Score 6 (5,7), and Charlson-Comorbidity-Index 7 (5,9). Actual 30-dm was 39.7%. Predicted and correlated mortality estimates were: NELA 58.8% (43.8,79.1), R²=0.40, AUC=0.8776, p<0.0001; ACS-NSQIP unadjusted 24.5% (9.2,42.2), R²=0.35, AUC=0.8497, p<0.0001; ACS-NSQIP risk somewhat higher 29.6% (14.0,44.2), R²=0.33, AUC=0.8370, p<0.0001; ACS-NSQIP risk significantly higher 29.6% (15.3,44.2), R²=0.31, AUC=0.8278, p<0.0001; and SORT 26.5% (19.1,44.4), R²=0.14, AUC=0.7197, p<0.0001. Data are presented as median±IQR. Risk prediction models correlate poorly with 30-dm and demonstrate substantial calibration error in elderly EL patients.