Hajibandeh Index versus NELA score in predicting mortality following emergency laparotomy: A retrospective Cohort Study

Hajibandeh, Shahab; Hajibandeh, Shahin; Waterman, Jennifer; Miller, Bethany; Johnson, Bethan; Higgi, Adnan; Hale, Jay; Pearce, Dafydd; Evans, Louis; Satyadas, Thomas; Mansour, Moustafa; Havard, Tim; Maw, Andrew

doi:10.1016/j.ijsu.2022.106645

Cited by 6 publications

(21 citation statements)

References 19 publications

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“…The necessity to improve the predictive performance of the NELA mortality score is absolute as it still underestimates both the 30-day and 90-day mortality following laparotomy. Hajibandeh et al [ 9 ] compared the predictive performance of the Hajibandeh Index (HI), which is derived from combined levels of C-reactive protein, lactate, neutrophils, lymphocytes, and albumin, with the NELA mortality score in predicting postoperative 30-day and 90-day mortality and concluded that HI was better than the NELA score in predicting postoperative mortality in patients aged over 80 undergoing emergency laparotomy while its performance was comparable with the NELA score in other subgroups [ 9 ]. The authors argued that the comparable performance of the HI and NELA model suggests that the NELA model may not efficiently take into account the parameters that it asks for [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hajibandeh et al [ 9 ] compared the predictive performance of the Hajibandeh Index (HI), which is derived from combined levels of C-reactive protein, lactate, neutrophils, lymphocytes, and albumin, with the NELA mortality score in predicting postoperative 30-day and 90-day mortality and concluded that HI was better than the NELA score in predicting postoperative mortality in patients aged over 80 undergoing emergency laparotomy while its performance was comparable with the NELA score in other subgroups [ 9 ]. The authors argued that the comparable performance of the HI and NELA model suggests that the NELA model may not efficiently take into account the parameters that it asks for [ 9 ]. These findings may suggest that the current predictive tools do not take into account the modern predictors of mortality efficiently and may indicate that future studies should focus on the development and validation of scoring systems that take into account all of the modern predictors of mortality in patients undergoing emergency laparotomy such as HI [ 9 ], age over 80 [ 3 , 4 ], sarcopenia [ 5 ], ASA status above 3 [ 3 , 4 ], need for bowel resection [ 4 ], and presence of intraperitoneal contamination [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…The authors argued that the comparable performance of the HI and NELA model suggests that the NELA model may not efficiently take into account the parameters that it asks for [ 9 ]. These findings may suggest that the current predictive tools do not take into account the modern predictors of mortality efficiently and may indicate that future studies should focus on the development and validation of scoring systems that take into account all of the modern predictors of mortality in patients undergoing emergency laparotomy such as HI [ 9 ], age over 80 [ 3 , 4 ], sarcopenia [ 5 ], ASA status above 3 [ 3 , 4 ], need for bowel resection [ 4 ], and presence of intraperitoneal contamination [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Such factors need to be carefully addressed preoperatively to assess the likelihood of survival after emergency laparotomy. Consequently, to facilitate more objective decision-making, several scoring systems aiming at predicting surgical outcomes have been developed [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Predictive Performance of NELA Versus P-POSSUM Mortality Scores: Are We Underestimating the Risk of Mortality Following Emergency Laparotomy?

Barghash¹,

Iskandar²,

Fawzy³

et al. 2022

Cureus

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BackgroundIn this study, we aimed to compare the performance of the National Emergency Laparotomy Audit (NELA) and Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (P-POSSUM) mortality risk scores in predicting 30-day and 90-day mortality in patients undergoing emergency laparotomy. MethodologyA retrospective cohort study was conducted to compare the predictive performance of preoperative NELA, postoperative NELA, and P-POSSUM predicted mortality scores in patients undergoing emergency laparotomy between 2014 and 2021. The outcomes of interest included the observed 30-day and 90-day mortality. The discrimination of the mortality tools was assessed and compared by determining the area under the curve (AUC) for each tool using the receiver operating characteristic curve analysis. ResultsA total of 681 patients were included. The observed risk of 30-day and 90-day mortality was 10.4% (71/681) and 14.2% (97/681), respectively. Regarding 30-day mortality, the AUC was 0.791 (0.727-0.855) for the preoperative NELA score, 0.784 (0.721-0.848) for the preoperative P-POSSUM score, and 0.761 (0.699-0.824) for the postoperative NELA score. Regarding 90-day mortality, the AUC was 0.765 (0.708-0.821) for the preoperative NELA score, 0.749 (0.692-0.807) for the preoperative P-POSSUM score, and 0.745 (0.691-0.800) for the postoperative NELA score. The observed/expected ratio for 30-day and 90-day mortality was 3.25 and 4.43 for preoperative NELA, 2.81 and 3.84 for preoperative P-POSSUM, and 2.17 and 2.96 for postoperative NELA, respectively. Pairwise comparisons showed no statistically significant difference in discrimination among the three models. ConclusionsPreoperative NELA, postoperative NELA, and P-POSSUM scores underestimated the risk of 30-day and 90day mortality in patients undergoing emergency laparotomy. No significant difference in predictive performance was found among the three models.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive Performance of NELA Versus P-POSSUM Mortality Scores: Are We Underestimating the Risk of Mortality Following Emergency Laparotomy?

Barghash¹,

Iskandar²,

Fawzy³

et al. 2022

Cureus

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“…We developed and validated a predictive model for predicting the risk of mortality after emergency laparotomy which includes three components: Hajibandeh index, ASA physical status and sarcopenia (HAS) [3]. The components of HAS remained in the model after multivariable analysis that included the following variables: ASA physical status; clinical frailty scale; sarcopenia; age; age ≥ 80 y; Hajibandeh index; need for bowel resection; and presence of peritoneal contamination [3]. The HAS is the first model demonstrating discrimination, calibration and classification in predicting the risk of mortality following emergency laparotomy.…”

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confidence: 99%

Objective measurement of age‐related physiological decline and vulnerability is still missing from the emergency laparotomy mortality predictive models

Hajibandeh

2023

Anaesthesia

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Development and Validation of HAS (Hajibandeh Index, ASA Status, Sarcopenia) - A Novel Model for Predicting Mortality After Emergency Laparotomy

Hajibandeh

Hughes

et al. 2023

Annals of Surgery

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Objectives: To develop and validate a predictive model to predict the risk of postoperative mortality after emergency laparotomy taking into account the following variables: age, age ≥ 80, ASA status, clinical frailty score, sarcopenia, Hajibandeh Index (HI), bowel resection, and intraperitoneal contamination. Summary Background Data: The discriminative powers of the currently available predictive tools range between adequate and strong; none has demonstrated excellent discrimination yet. Methods: The TRIPOD and STROCSS statement standards were followed to protocol and conduct a retrospective cohort study of adult patients who underwent emergency laparotomy due to non-traumatic acute abdominal pathology between 2017 and 2022. Multivariable binary logistic regression analysis was used to develop and validate the model via two protocols (Protocol A and B). The model performance was evaluated in terms of discrimination (ROC curve analysis), calibration (calibration diagram and Hosmer-Lemeshow test), and classification (classification table). Results: One thousand forty-three patients were included (statistical power = 94%). Multivariable analysis kept HI (Protocol-A: P=0.0004; Protocol-B: P=0.0017), ASA status (Protocol-A: P=0.0068; Protocol-B: P=0.0007), and sarcopenia (Protocol-A: P<0.0001; Protocol-B: P<0.0001) as final predictors of 30-day postoperative mortality in both protocols; hence the model was called HAS (HI, ASA status, sarcopenia). The HAS demonstrated excellent discrimination (AUC: 0.96, P<0.0001), excellent calibration (P<0.0001), and excellent classification (95%) via both protocols. Conclusions: The HAS is the first model demonstrating excellent discrimination, calibration, and classification in predicting the risk of 30-day mortality following emergency laparotomy. The HAS model seems promising and is worth attention for external validation using the calculator provided. HAS mortality risk calculator https://app.airrange.io/#/element/xr3b_E6yLor9R2c8KXViSAeOSK.

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Hajibandeh Index versus NELA score in predicting mortality following emergency laparotomy: A retrospective Cohort Study

Cited by 6 publications

References 19 publications

Predictive Performance of NELA Versus P-POSSUM Mortality Scores: Are We Underestimating the Risk of Mortality Following Emergency Laparotomy?

Predictive Performance of NELA Versus P-POSSUM Mortality Scores: Are We Underestimating the Risk of Mortality Following Emergency Laparotomy?

Objective measurement of age‐related physiological decline and vulnerability is still missing from the emergency laparotomy mortality predictive models

Development and Validation of HAS (Hajibandeh Index, ASA Status, Sarcopenia) - A Novel Model for Predicting Mortality After Emergency Laparotomy

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