SHARP risk score: A predictor of poor outcomes in adults admitted for emergency general surgery: A prospective cohort study

Panayiotis Tanos; Andrew D Ablett; Ben Carter; Wim Ceelen; Lyndsay Pearce; Michael Stechman; Kathryn McCarthy; Jonathan Hewitt; Phyo Kyaw Myint

doi:10.1016/j.asjsur.2022.10.049

SHARP risk score: A predictor of poor outcomes in adults admitted for emergency general surgery: A prospective cohort study

Asian J Surg. 2023 Jul;46(7):2668-2674. doi: 10.1016/j.asjsur.2022.10.049. Epub 2022 Nov 5.

Authors

Panayiotis Tanos¹, Andrew D Ablett², Ben Carter³, Wim Ceelen⁴, Lyndsay Pearce⁵, Michael Stechman⁶, Kathryn McCarthy⁷, Jonathan Hewitt⁸, Phyo Kyaw Myint⁹

Affiliations

¹ Institute of Applied Health Sciences, University of Aberdeen & Aberdeen Royal Infirmary, NHS Grampian, United Kingdom; Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom.
² Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom; Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, United Kingdom.
³ Department of Biostatistics and Health Informatics, Institute of Psychology Psychiatry and Neuroscience, King's College London, United Kingdom.
⁴ Department of GI Surgery, University Hospital, Ghent, Belgium.
⁵ Department of General Surgery, Salford Royal Hospital, United Kingdom.
⁶ Department of General and Endocrine Surgery, University Hospital of Wales, Cardiff, United Kingdom.
⁷ Department of General Surgery, North Bristol NHS Trust, United Kingdom.
⁸ Department of Population Medicine, Cardiff University, United Kingdom. Electronic address: hewittj2@cardiff.ac.uk.
⁹ Ageing Clinical and Experimental Research Team, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom.

PMID: 36347742
DOI: 10.1016/j.asjsur.2022.10.049

Abstract

Purpose: Post-operative complications following emergency abdominal surgery are associated with significant morbidity and mortality. Despite the knowledge of prognostic factors associated with poor surgical outcomes; few have described risks of poor outcomes based on admission information in acute surgical setting. We aimed to derive a simple, point-of-care risk scale that predicts adults with increased risk of poor outcomes.

Methods: We used data from an international multi-centre prospective cohort study. The effect of characteristics; age, hypoalbuminaemia, anaemia, renal insufficiency and polypharmacy on 90-day mortality was examined using fully adjusted multivariable models. For our secondary outcome we aimed to test whether these characteristics could be combined to predict poor outcomes in adults undergoing emergency general surgery. Subsequently, the impact of incremental increase in derived SHARP score on outcomes was assessed.

Results: The cohort consisted of 419 adult patients between the ages of 16-94 years (median 52; IQR(39) consecutively admitted to five emergency general surgical units across the United Kingdom and one in Ghent, Belgium. In fully adjusted models the aforementioned characteristics; were associated with 90-day mortality. SHARP score was associated with higher odds of mortality in adults who underwent emergency general surgery, with a SHARP score of five also being associated with an increased length of hospital stay.

Conclusions: SHARP risk score is a simple prognostic tool, using point-of-care information to predict poor outcomes in patients undergoing emergency general surgery. This information may be used to improve management plans and aid clinicians in delivering more person-centred care. Further validation studies are required to prove its utility.

Keywords: Anaemia; Elderly; Emergency general surgery; Frailty; Polypharmacy; Prospective cohort study; Renal impairment.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Hospitalization*
Humans
Length of Stay
Middle Aged
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology
Prospective Studies
Risk Factors
Young Adult