Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May 5:9:13.
doi: 10.1186/s13741-020-00143-7. eCollection 2020.

Functional performance and 30-day postoperative mortality after emergency laparotomy-a retrospective, multicenter, observational cohort study of 1084 patients

Mirjana Cihoric  1 , Line Toft Tengberg  2 , Nicolai Bang Foss  1 , Ismail Gögenur  2 , Mai-Britt Tolstrup  3 , Morten Bay-Nielsen  4
Affiliations

Functional performance and 30-day postoperative mortality after emergency laparotomy-a retrospective, multicenter, observational cohort study of 1084 patients

Mirjana Cihoric et al. Perioper Med (Lond). .

Abstract

Background: Despite the importance of predicting adverse postoperative outcomes, functional performance status as a proxy for frailty has not been systematically evaluated in emergency abdominal surgery. Our aim was to evaluate if the Eastern Cooperative Oncology Group (ECOG) performance score was independently associated with mortality following high-risk emergency abdominal surgery, in a multicentre, retrospective, observational study of a consecutive cohort.

Methods: All patients aged 18 or above undergoing high-risk emergency laparotomy or laparoscopy from four emergency surgical centres in the Capitol Region of Denmark, from January 1 to December 31, 2012, were included. Demographics, preoperative status, ECOG performance score, mortality, and surgical characteristics were registered. The association of frailty with postoperative mortality was evaluated using multiple regression models. Likelihood ratio test was applied for goodness of fit.

Results: In total, 1084 patients were included in the cohort; unadjusted 30-day mortality was 20.2%. ECOG performance score was independently associated with 30-day mortality. Odds ratio for mortality was 1.70 (95% CI (1.0, 2.9)) in patients with ECOG performance score of 1, compared with 5.90 (95% CI (1.8, 19.0)) in patients with ECOG performance score of 4 (p < 0.01). Likelihood ratio test suggests improvement in fit of logistic regression modelling of 30-day postoperative mortality when including ECOG performance score as an explanatory variable.

Conclusions: This study found ECOG performance score to be independently associated with the postoperative 30-day mortality among patients undergoing high-risk emergency laparotomy. The utility of including functional performance in a preoperative risk assessment model of emergency laparotomy should be evaluated.

Keywords: 30-day mortality; Emergency laparotomy; Frailty.

PubMed Disclaimer

Conflict of interest statement

Competing interestsThere are no known potential or real conflicts of interest.

Figures

Fig. 1
Fig. 1
Eastern Cooperative Oncology Group (ECOG) Performance score
Fig. 2
Fig. 2
Kaplan–Meier estimated survival within days of acute abdominal surgery stratified according to ECOG performance score
Fig. 3
Fig. 3
Changes in mortality with increasing ECOG performance score, independently of ASA score
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Akyar S, Armenia SJ, Ratnani P, Merchant AM. The impact of frailty on postoperative cardiopulmonary complications in the emergency general surgery population. Surg J (New York, NY). 2018;4(2):e66–77. Available from: http://www.ncbi.nlm.nih.gov/pubmed/29796424. - PMC - PubMed
    1. Buccheri G, Ferrigno D, Tamburini M. Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer Part A. 1996;32(7):1135–1141. doi: 10.1016/0959-8049(95)00664-8. - DOI - PubMed
    1. Chandra A, Mangam S, Marzouk D. A review of risk scoring systems utilised in patients undergoing gastrointestinal surgery. J Gastrointest Surg. 2009 [cited 2013 Mar 7];13(8):1529–38. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19319612. - PubMed
    1. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign. Crit Care Med. 2013;41(2):580–637. Available from: papers2://publication/doi/10.1097/CCM.0b013e31827e83af. - PubMed
    1. Eugene N, Oliver CM, Bassett MG, Poulton TE, Kuryba A, Johnston C, et al. Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery: the National Emergency Laparotomy Audit risk model. Br J Anaesth. 2018;121(4):739–48. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30236236. - PubMed

LinkOut - more resources