• Simon Juul, Dunja Kokotovic, Thea Helene Degett, Jakob Ohm Oreskov, Sarah Ekeloef, Ismail Gögenur, and Jakob Burcharth.
• Department of Surgery, Center for Surgical Science, Sjaellands Universitetshospital Koge, Lykkebækvej 1, 4600, Køge, Denmark. simon.juul@gmail.com.
• Eur J Trauma Emerg Surg. 2021 Dec 1; 47 (6): 1721-1727.

PurposePatients undergoing major emergency abdominal surgery have a high mortality rate. Preoperative risk prediction tools of in-hospital mortality could assist clinical identification of patients at increased risk and thereby aid clinical decision-making and postoperative pathways. The aim of this study was to validate the preoperative score to predict mortality (POSPOM) in a population of patients undergoing major emergency abdominal surgery.MethodsPOSPOM was investigated in a retrospectively collected cohort of patients undergoing major emergency abdominal surgery at a Danish University Hospital from 2010 to 2016. Predicted in-hospital mortality by POSPOM was compared to observed in-hospital mortality. Calibration was assessed by Hosmer-Lemeshow goodness-of-fit and calibration plot. Discrimination was assessed by area under the receiver operating characteristic curve and accuracy was assessed with Brier score.ResultsThe study included 979 patients (513 females) with a median age of 64 (IQR 55-77) years. The majority of patients underwent open surgery (94.5%). The observed in-hospital mortality rate was 10.9%. The estimated mean in-hospital mortality rate by POSPOM was 6.7%. POSPOM showed a good discrimination [AUC 0.82 (95% CI 0.78-0.85)] and an excellent accuracy [Brier score 0.09 (95% CI 0.07-0.10)]. However, a poor calibration was found (p < 0.01) as POSPOM underestimated in-hospital mortality.ConclusionsPOSPOM is not an ideal prediction model for in-hospital mortality in patients undergoing major emergency abdominal surgery due a poor calibration.© 2019. Springer-Verlag GmbH Germany, part of Springer Nature.

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