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A practical risk scale for predicting morbidity and mortality in the emergency general surgical setting: A prospective multicenter study

Research output: Contribution to journalArticle

A.D. Ablett, K. McCarthy, B. Carter, L. Pearce, M. Stechman, S. Moug, W. Ceelen, J. Hewitt, P.K. Myint

Original languageEnglish
JournalInternational Journal Of Surgery
Early online date24 Nov 2018
Accepted/In press19 Nov 2018
E-pub ahead of print24 Nov 2018


King's Authors


Background Low albumin is a poor prognostic factor for surgical outcomes. We aimed to examine the predicative ability of easily obtainable point of care variables in combination to low albumin level to derive a practical risk scale for predicting older adults at risk of poor outcomes on admission to the emergency general surgical setting. Methods This is an international multi-center prospective cohort study conducted as part of the Older Persons Surgical Outcomes Collaboration ( The effect of having hypoalbuminemia (defined as albumin ≤3.5  g/dL) on selected outcomes was examined using fully adjusted multivariable models. In a subgroup of patients with hypoalbuminemia, we observed four risk characteristics (Male, Anemia, Low albumin, Eighty-five and over [MALE]). Subsequently, the impact of incremental increase in MALE score (each characteristic scoring 1 point (maximum score 4) on measured outcomes was assessed. Results The cohort consisted of 1406 older patients with median (IQR) age of 76 (70–83) years. In fully adjusted models, hypoalbuminemia was significantly associated with undergoing emergency surgery (1.32 (95%CI 1.03–1.70); p = 0.03), 30-day mortality (4.23 (2.22–8.08); p 

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