1. Preoperative mortality risk evaluation in abdominal surgical emergencies: development and internal validation of the NDAR score from a national multicenter audit in Senegal
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Abdourahmane Ndong, Adja Coumba Diallo, Lebem Togtoga, Magatte Faye, Pape Mamadou Faye, Ahmed Diouf, Ndiamé Sarr, Abdou Niasse, Aliou Coly Faye, Cheikh Tidiane Mbaye, Mamadou Saidou Bah, Pape Djibril Ndoye, Mohamed Doukoure, Moussa Guira, Cheikh Tidiane Ka, Bathie Massamba Diouf, Thierno Faye, Foulaké Tandian, Thierno Amadou Telly Dialllo, Modou Gaye, Ngueidio Yamingué, Housseynou Kama, Emmanuel Kazubwenge, Mbaye Thiam, Abdou Dahim Diack, Mamadou Arame Ndiaye, Abamou Babara, Cheikh Samb, Cheikh Hameth Badji, Christine Marie Joseph Diouf, Sidy Mouhamed Abdoulaye Fall, Mamadouba Camara, Julien Ibrahima Faye, Abdou Khadre Niang, Pape Souleymane Dieng, Ablaye Ndiaye, Diago Anta Dia, Omar Sow, Abib Diop, Yacine Seye, Ibrahima Souleymane Sitor Sarr, Mohamadou Lamine Gueye, Mohamed Lamine Diao, Philipe Manyacka, Eugène Gaudens Prosper Amaye Diémé, Ibrahima Sall, Oumar Fall, Alamasso Sow, Jacques Noel Tendeng, Ousmane Thiam, Mamadou Seck, Cheikh Diouf, Ibrahima Ka, Alpha Oumar Touré, Balla Diop, Pape Ablaye Ba, Pape Saloum Diop, Mamadou Cissé, Khadim Niang, and Ibrahima Konaté
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Emergency ,Abdomen ,Africa ,Mortality ,Surgery ,Score ,RD1-811 - Abstract
Abstract Introduction Abdominal surgical emergencies have a high mortality rate. Effective management primarily relies on the early identification of patients at high risk of postoperative complications. The objective of our study was to determine the prognostic factors associated with poor outcomes from abdominal surgical emergencies in Senegal and to establish a predictive score for mortality for preoperative risk evaluation (NDAR (New Death Assessment Risk) score). Methodology This was a retrospective national cross-sectional study conducted over one year in 14 regions of Senegal. Adult patients (aged > 15 years) who presented with a traumatic or non-traumatic abdominal surgical emergency were included. The studied variables included clinical and paraclinical data. The variable of interest was death within 30 days of the surgery. Logistic regression was used to identify the factors independently associated with mortality. Risk factors identified after logistic regression analysis were weighted using odds ratio (OR) values rounded to the nearest whole number. The predictive capacity of the score was evaluated by analyzing the ROC (Receiver Operating Characteristic) curve based on the area under the curve (AUC). Results A total of 1114 patient records were included, with a mortality rate of 4.4%. Diagnoses were observed in patients included appendicitis in 39.8% of cases (n = 444), followed by peritonitis in 22.3% (n = 249), intestinal obstruction in 18.5% (n = 205), strangulated hernias in 10.5% (n = 117), and abdominal trauma in 6.1%. Logistic regression, established the following scores: age > 40 years (score 2), ASA status grade 2 or higher (score 1), presence of a positive QSIRS score (score 2), diagnosis of peritonitis (score 2), diagnosis of intestinal obstruction (score 1), and the presence of intestinal necrosis (score 3). The score is positive if the total is strictly greater than 5, indicating a 17.7% risk of mortality. This score had a high predictive capacity with an AUC of 0.7397. Conclusion This study enabled the establishment of a score that allows for the early identification of at-risk patients, even in constrained resource settings, facilitating appropriate perioperative management and timely surgical intervention to reduce the risk of complications. This approach, focused on early recognition of high-risk patients, is crucial for improving clinical outcomes in abdominal surgical emergencies.
- Published
- 2024
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