TY - JOUR
T1 - Outcome in patients with open abdomen treatment for peritonitis
T2 - a multidomain approach outperforms single domain predictions
AU - Petersen, Sven
AU - Huber, Markus
AU - Storni, Federico
AU - Puhl, Gero
AU - Deder, Alice
AU - Prause, Axel
AU - Schefold, Joerg C.
AU - Doll, Dietrich
AU - Schober, Patrick
AU - Luedi, Markus M.
N1 - Funding Information: The authors acknowledge Jeannie Wurz, Bern University Hospital, for editing the manuscript. Publisher Copyright: © 2021, The Author(s).
PY - 2022/8
Y1 - 2022/8
N2 - Numerous patient-related clinical parameters and treatment-specific variables have been identified as causing or contributing to the severity of peritonitis. We postulated that a combination of clinical and surgical markers and scoring systems would outperform each of these predictors in isolation. To investigate this hypothesis, we developed a multivariable model to examine whether survival outcome can reliably be predicted in peritonitis patients treated with open abdomen. This single-center retrospective analysis used univariable and multivariable logistic regression modeling in combination with repeated random sub-sampling validation to examine the predictive capabilities of domain-specific predictors (i.e., demography, physiology, surgery). We analyzed data of 1,351 consecutive adult patients (55.7% male) who underwent open abdominal surgery in the study period (January 1998 to December 2018). Core variables included demographics, clinical scores, surgical indices and indicators of organ dysfunction, peritonitis index, incision type, fascia closure, wound healing, and fascial dehiscence. Postoperative complications were also added when available. A multidomain peritonitis prediction model (MPPM) was constructed to bridge the mortality predictions from individual domains (demographic, physiological and surgical). The MPPM is based on data of n = 597 patients, features high predictive capabilities (area under the receiver operating curve: 0.87 (0.85 to 0.90, 95% CI)) and is well calibrated. The surgical predictor “skin closure” was found to be the most important predictor of survival in our cohort, closely followed by the two physiological predictors SAPS-II and MPI. Marginal effects plots highlight the effect of individual outcomes on the prediction of survival outcome in patients undergoing staged laparotomies for treatment of peritonitis. Although most single indices exhibited moderate performance, we observed that the predictive performance was markedly increased when an integrative prediction model was applied. Our proposed MPPM integrative prediction model may outperform the predictive power of current models.
AB - Numerous patient-related clinical parameters and treatment-specific variables have been identified as causing or contributing to the severity of peritonitis. We postulated that a combination of clinical and surgical markers and scoring systems would outperform each of these predictors in isolation. To investigate this hypothesis, we developed a multivariable model to examine whether survival outcome can reliably be predicted in peritonitis patients treated with open abdomen. This single-center retrospective analysis used univariable and multivariable logistic regression modeling in combination with repeated random sub-sampling validation to examine the predictive capabilities of domain-specific predictors (i.e., demography, physiology, surgery). We analyzed data of 1,351 consecutive adult patients (55.7% male) who underwent open abdominal surgery in the study period (January 1998 to December 2018). Core variables included demographics, clinical scores, surgical indices and indicators of organ dysfunction, peritonitis index, incision type, fascia closure, wound healing, and fascial dehiscence. Postoperative complications were also added when available. A multidomain peritonitis prediction model (MPPM) was constructed to bridge the mortality predictions from individual domains (demographic, physiological and surgical). The MPPM is based on data of n = 597 patients, features high predictive capabilities (area under the receiver operating curve: 0.87 (0.85 to 0.90, 95% CI)) and is well calibrated. The surgical predictor “skin closure” was found to be the most important predictor of survival in our cohort, closely followed by the two physiological predictors SAPS-II and MPI. Marginal effects plots highlight the effect of individual outcomes on the prediction of survival outcome in patients undergoing staged laparotomies for treatment of peritonitis. Although most single indices exhibited moderate performance, we observed that the predictive performance was markedly increased when an integrative prediction model was applied. Our proposed MPPM integrative prediction model may outperform the predictive power of current models.
KW - Abdomen/surgery
KW - Adult
KW - Female
KW - Humans
KW - Laparotomy
KW - Male
KW - Open Abdomen Techniques
KW - Peritonitis/surgery
KW - Retrospective Studies
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85110491812&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/34247307
UR - http://www.scopus.com/inward/record.url?scp=85110491812&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s10877-021-00743-8
DO - https://doi.org/10.1007/s10877-021-00743-8
M3 - Article
C2 - 34247307
SN - 1387-1307
VL - 36
SP - 1109
EP - 1119
JO - Journal of clinical monitoring and computing
JF - Journal of clinical monitoring and computing
IS - 4
ER -