Development and validation of a novel preoperative risk stratification tool to predict one-year mortality for older patients after emergency laparotomy: the SArC calculator
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Sarcopenia and low skeletal muscle index (SMI) are associated with high major morbidity and mortality following emergency laparotomy (EL). Existing preoperative risk models often focus on short-term outcomes. This study aimed to develop a personalised preoperative score using SMI to predict 1-year mortality in older patients undergoing EL. METHODS: This was a retrospective study conducted in patients aged ≥65 years who underwent EL from January 2016 to December 2022. Patients who underwent EL for trauma, vascular surgery or cholecystectomy were excluded. The cut-off values for low SMI were <33.4 and 26.3 cm 2 /m 2 for males and females, respectively. Univariate and multivariate logistic regression analyses were performed to identify the predictors of 1-year mortality. Receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test were used to evaluate the model performance. RESULTS: A total of 477 patients (training cohort: n = 334, validation cohort: n = 143) were included in the analysis. Of these patients, 41.5% had sarcopenia. The incidences of Clavien-Dindo grade III morbidity, grade IV morbidity, in-hospital mortality and 1-year mortality were 6.7%, 8.0%, 6.3% and 18.5%, respectively. Multivariate analyses showed that sarcopenia (odds ratio [OR] 4.42, 95% confidence interval [CI] 1.69-11.57), American Society of Anesthesiologists score (OR 2.37, 95% CI 1.23-4.54) and clinical frailty scale (OR 1.83, 95% CI 1.30-2.59) were independent predictors for 1-year mortality. The area under the ROC curve was 0.79 (95% CI 0.71-0.88) and 0.73 (95% CI 0.58-0.87) in the training and validation cohorts, respectively. Hosmer-Lemeshow test was not statistically significant. CONCLUSION: We developed an easy-to-use preoperative calculator to predict 1-year mortality in older patients undergoing EL.
Source: Singapore Medical Journal
Authors: Kai Siang Chan, Geraldine Yanlei Lei, Angelica Jia Qi Koh, Sivasubramanian Srinivasan, Woan Wui Lim, Serena Low, Jerry Tiong Thye Goo, Daniel Jin Keat Lee
Institutions: Khoo Teck Puat Hospital, UNSW Sydney
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7136041220