EP.FRI.8 Hajibandeh index predicts nature of peritoneal contamination and risk of postoperative mortality in patients with acute abdominal pathology: A multicentre cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Jigar Shah ◽  
Moustafa Mansour
Keyword(s):  
Cohort Study ◽  
Validation Cohort ◽  
Postoperative Mortality ◽  
Operative Management ◽  
Emergency Laparotomy ◽  
Roc Curve Analysis ◽  
Peritoneal Contamination ◽  
Multicentre Cohort Study ◽  
Non Operative Management ◽  
Multicentre Cohort

Abstract Aims To develop and validate intraperitoneal contamination index, Hajibandeh Index (HI), derived from combined levels of CRP, lactate, neutrophils, lymphocytes and albumin in predicting the nature of peritoneal contamination and risk of postoperative mortality in patients with acute abdominal pathology. Methods A multicentre cohort study was conducted to develop and validate an index to predict presence of purulent and feculent contamination and risk of postoperative mortality in patients with acute abdominal pathology. All adult patients with acute abdominal pathology requiring emergency laparotomy between 2014 and 2020 were included. The index was developed in a primary cohort and was validated in retrospective and prospective validation cohorts. ROC curve analysis was performed to determine discrimination of the index and cut-off values of HI that could predict nature of peritoneal contamination and postoperative mortality. Results 737 patients were included (234 in primary cohort, 234 in retrospective validation cohort, and 269 in prospective validation cohort). The analyses identified HI of 24.76 as cut-off value for purulent contamination (AUC:0.78,P<0.0001;sensitivity:82.4%,specificity:60.9%); HI of 33.84 as cut-off value for feculent contamination (AUC:0.78, P<0.0001;sensitivity:82%,specificity:67.8%), and HI of 33.47 as cut-off value for postoperative mortality (AUC:0.70,P<0.0001;sensitivity:72.7%, specificity:58.47%). The results of the primary cohort and validation cohorts were comparable. Conclusions HI predicts presence of purulent and feculent contamination in patients with acute abdominal pathology and risk of postoperative mortality in patients undergoing emergency laparotomy. Future studies should investigate the effect of HI on accuracy of preoperative prognostic scoring tools and on patient selection for operative or non-operative management of underlying abdominal pathology.

scholarly journals BJS.01Antibiotics as an alternative to appendicectomy in uncomplicated adult appendicitis: analysis of a prospective, multicentre cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Hannah Javanmard-Emamghissi ◽  
Brett Doleman ◽  
Marianne Hollyman ◽  
Jonathan Lund ◽  
Susan Moug ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Large Scale ◽  
Day Treatment ◽  
Operative Management ◽  
Co Morbidity ◽  
Multicentre Cohort Study ◽  
Non Operative Management ◽  
Multicentre Cohort

Abstract Aims Recent randomised controlled trials have shown that non-operative management of acute appendicitis with antibiotics can prevent the need for surgery in 71-84% of patients within 90-days.  Changes in the management of appendicitis, brought about by the COVID-19 pandemic, have allowed for this large-scale observational study, which aims to report the outcomes of operative and non-operative management of appendicitis, including non-operative management rates at 90-days. Methods This prospective, multicentre cohort study at 97 sites across Great Britain and Ireland included adult patients with a clinical or radiological diagnosis of appendicitis. Propensity-score matching was conducted using age, sex, BMI, frailty, co-morbidity, adult appendicitis score and CRP. Outcomes in the non-operative group were 90-day treatment failure, and in the matched groups 30-day complications and length of hospital stay (LOS). Results This analysis included 3420 patients, of whom 1402 (41%) had initial non-operative treatment and 2018 (59%) had operative management. The success rate of non-operative management was 80% (1116) at 90-days, with 18 patients (6%) that failed non-operative management having a histologically normal appendix. Following propensity score matching, 2444 patients were included in the outcomes analysis. In the propensity score matched groups, there was a reduction in complications in the non-operative management group compared to the operative group (OR 0.36; 95% CI 0.26 to 0.50) and a shorter median LOS (2.5 vs 3 days, p < 0.001). Conclusions Non-operative management of appendicitis is associated with fewer complications, a shorter LOS, and avoids surgery in the majority of patients.

scholarly journals TP9.2.10The risk and predictors of mortality in octogenarians undergoing emergency laparotomy: A multicentre cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shahab Hajibandeh ◽  
Shahin Hajibandeh ◽  
Jigar Shah ◽  
Andrew Maw ◽  
Moustafa Mansour ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Postoperative Mortality ◽  
Binary Logistic Regression ◽  
Assessment Tools ◽  
Secondary Outcome ◽  
Emergency Laparotomy ◽  
Peritoneal Contamination ◽  
Significant Difference

Abstract Aims To evaluate the risk and predictors of postoperative mortality in octogenarians undergoing emergency laparotomy. Methods In compliance with STROCSS guideline for observational studies, we conducted a multicentre retrospective cohort study. All consecutive patients aged over 80 with acute abdominal pathology requiring emergency laparotomy between April 2014 and August 2019 were considered eligible for inclusion. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measures were in-hospital mortality and 1-year mortality. Statistical analyses included simple descriptive statistics, binary logistic regression analyses, and Kaplan–Meier survival statistics. Results A total of 523 octogenarians were eligible for inclusion. Emergency laparotomy in octogenarians was associated with 21.8% (95% CI 18.3-25.6%) 30-day postoperative mortality, 22.6% (95% CI 19.0-26.4%) in-hospital mortality, and 40.2% (95% CI 35.9-44.5%) 1-year mortality. Binary logistic regression analysis identified ASA status (OR: 2.49,95% CI 1.82-3.38,P<0.0001) and peritoneal contamination (OR: 2.00, 95% CI 1.30-3.08, P = 0.002) as predictors of 30-day postoperative mortality. The ASA status (OR: 1.92,95% CI 1.50-2.46,P<0.0001), peritoneal contamination (OR: 1.57,95% CI 1.07-2.48,P=0.020) and presence of malignancy (OR: 2.06,95% CI 1.36-3.10,P=0.001) were predictors of 1-year mortality. Log-rank test showed significant difference in postoperative survival rates among patients with different ASA status (P < 0.0001) and between patients with and without peritoneal contamination (P = 0.0011). Conclusions Emergency laparotomies in patients older than 80 years with ASA status more than 3 in the presence of peritoneal contamination carries a high risk of immediate postoperative and 1-year mortality. There is a need to incorporate modern prognosticators into the available preoperative mortality risk assessment tools.

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