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

Abstract

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.

Safety and feasibility of colonoscopy in nonagenarians: A systematic review, meta‐analysis and meta‐regression analysis

“…The findings of the current study, together with those of the aforementioned studies, suggest that age alone should not be a reason for failing to offer colonoscopy to patients aged 90 or above. It is well established that ASA status, sarcopenia, decreased physiological reserve and increased vulnerability associated with aging‐related physiological deficits are more important predictors of complications and mortality than age itself [20]. Provided that already established contraindications for bowel preparation including the concerns raised by the UK National Patient Safety Agency (NPSA) are avoided [21], the risks of complications related to bowel preparation and procedural complications in nonagenarians with good performance status are low, and indeed our results support this argument.…”

HAS model seems promising in predicting mortality after emergency laparotomy and is worth attention for external validation using the HAS calculator

“…The components of HAS remained in the model after a very strict multivariable analysis including the following variables: ASA status, clinical frailty scale, sarcopenia, age, age ≥ 80, HI, need for bowel resection, and presence of peritoneal contamination. 2 The HAS model is the first model demonstrating excellent discrimination (AUC: 0.96), excellent calibration, and excellent classification in predicting the risk of 30-day mortality following emergency laparotomy. 2 The performance of HAS can be explained by several factors.…”

“…2 The HAS model is the first model demonstrating excellent discrimination (AUC: 0.96), excellent calibration, and excellent classification in predicting the risk of 30-day mortality following emergency laparotomy. 2 The performance of HAS can be explained by several factors. It considers the severity of underlying abdominal pathology via HI which is strongly correlated with presence of intestinal ischaemia, tissue necrosis, or peritoneal contamination.…”

“…We support the recommendations by Ming et al 1 as they are indeed in line with the findings of our recent study. 2 We recently developed and validated a predictive model called HAS for predicting the risk of mortality after emergency laparotomy. The HAS model includes three components: Hajibandeh Index (HI), ASA status, and sarcopenia.…”

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

“…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.…”