A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting

a prospective multicenter study

A. D. Ablett, K. McCarthy, B. Carter, L. Pearce, M. Stechman, S. Moug, W. Ceelen, J. Hewitt, P. K. Myint (Corresponding Author), Older Persons Surgical Outcomes Collaboration (OPSOC)

Research output: Contribution to journalArticle

Abstract

Background: Low albumin is a poor prognostic factor for surgical outcomes. We aimed to examine the predicative ability of easily obtainable point of care variables in combination to low albumin level 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 ≤3.5g/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.
Original languageEnglish
Pages (from-to)236-244
Number of pages9
JournalInternational Journal of Surgery
Volume60
Early online date24 Nov 2018
DOIs
Publication statusPublished - Dec 2018

Fingerprint

Multicenter Studies
Emergencies
Hypoalbuminemia
Prospective Studies
Albumins
Morbidity
Point-of-Care Systems
Mortality
Length of Stay
Geriatric Assessment
Anemia
Cohort Studies

Keywords

  • hypoalbuminemia
  • mortality
  • increased length of hospital stay
  • older adults
  • emergency surgical admissions
  • prognosis

Cite this

Ablett, A. D., McCarthy, K., Carter, B., Pearce, L., Stechman, M., Moug, S., ... Older Persons Surgical Outcomes Collaboration (OPSOC) (2018). A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: a prospective multicenter study. International Journal of Surgery , 60, 236-244. https://doi.org/10.1016/j.ijsu.2018.11.023

A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting : a prospective multicenter study. / Ablett, A. D.; McCarthy, K.; Carter, B.; Pearce, L.; Stechman, M.; Moug, S.; Ceelen, W.; Hewitt, J.; Myint, P. K. (Corresponding Author); Older Persons Surgical Outcomes Collaboration (OPSOC).

In: International Journal of Surgery , Vol. 60, 12.2018, p. 236-244.

Research output: Contribution to journalArticle

Ablett, AD, McCarthy, K, Carter, B, Pearce, L, Stechman, M, Moug, S, Ceelen, W, Hewitt, J, Myint, PK & Older Persons Surgical Outcomes Collaboration (OPSOC) 2018, 'A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: a prospective multicenter study', International Journal of Surgery , vol. 60, pp. 236-244. https://doi.org/10.1016/j.ijsu.2018.11.023
Ablett, A. D. ; McCarthy, K. ; Carter, B. ; Pearce, L. ; Stechman, M. ; Moug, S. ; Ceelen, W. ; Hewitt, J. ; Myint, P. K. ; Older Persons Surgical Outcomes Collaboration (OPSOC). / A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting : a prospective multicenter study. In: International Journal of Surgery . 2018 ; Vol. 60. pp. 236-244.
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abstract = "Background: Low albumin is a poor prognostic factor for surgical outcomes. We aimed to examine the predicative ability of easily obtainable point of care variables in combination to low albumin level 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 ≤3.5g/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.",
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T1 - A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting

T2 - a prospective multicenter study

AU - Ablett, A. D.

AU - McCarthy, K.

AU - Carter, B.

AU - Pearce, L.

AU - Stechman, M.

AU - Moug, S.

AU - Ceelen, W.

AU - Hewitt, J.

AU - Myint, P. K.

AU - Older Persons Surgical Outcomes Collaboration (OPSOC)

N1 - We acknowledge the support of the National Institute for Health Research (NIHR) Biomedical Research Center at South London and Maudsley NHS Foundation Trust and King's College London (BC).

PY - 2018/12

Y1 - 2018/12

N2 - Background: Low albumin is a poor prognostic factor for surgical outcomes. We aimed to examine the predicative ability of easily obtainable point of care variables in combination to low albumin level 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 ≤3.5g/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.

AB - Background: Low albumin is a poor prognostic factor for surgical outcomes. We aimed to examine the predicative ability of easily obtainable point of care variables in combination to low albumin level 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 ≤3.5g/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.

KW - hypoalbuminemia

KW - mortality

KW - increased length of hospital stay

KW - older adults

KW - emergency surgical admissions

KW - prognosis

U2 - 10.1016/j.ijsu.2018.11.023

DO - 10.1016/j.ijsu.2018.11.023

M3 - Article

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SP - 236

EP - 244

JO - International Journal of Surgery

JF - International Journal of Surgery

SN - 1743-9159

ER -