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Preoperative mortality risk evaluation in abdominal surgical emergencies: development and internal validation of the NDAR score from a national multicenter audit in Senegal

Authors :
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
Ibrahima Konaté
Source :
BMC Surgery, Vol 24, Iss 1, Pp 1-9 (2024)
Publication Year :
2024
Publisher :
BMC, 2024.

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.

Details

Language :
English
ISSN :
14712482
Volume :
24
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Surgery
Publication Type :
Academic Journal
Accession number :
edsdoj.08292d1abeac43ffb54db44af722ad30
Document Type :
article
Full Text :
https://doi.org/10.1186/s12893-024-02613-x