The Emergency Surgery Score (ESS) accurately predicts the occurrence of postoperative complications in emergency surgery patients. Issue 1 (July 2017)

• Record Type: Journal Article
• Authors: Nandan, Anirudh R.; Bohnen, Jordan D.; Sangji, Naveen F.; Peponis, Thomas; Han, Kelsey; Yeh, D. Dante; Lee, Jarone; Saillant, Noelle; De Moya, Marc; Velmahos, George C.; Chang, David C.; Kaafarani, Haytham M.A.
• Is Part Of: Journal of trauma and acute care surgery. Volume 83:Issue 1(2017)
• Publication Date: 2017-07
• Subjects: Emergency surgery score -- postoperative complications -- emergency surgery; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000001500
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : BACKGROUND: The Emergency Surgery Score (ESS) was recently validated as a scoring system to predict mortality in emergency surgery (ES) patients. We sought to examine the ability of ESS to predict the occurrence of 30-day postoperative complications in ES. METHODS: The 2011–2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was screened for all surgical operations classified as "emergent." Thirty-day postoperative complications were defined as per ACS-NSQIP (e.g., surgical site infection, respiratory failure, acute renal failure). Each patient-related ESS was calculated, and the correlation between ESS and the probability of occurrence of 30-day postoperative complications was assessed by calculating the c-statistic. Univariate and multivariable models were also created to identify which ESS components independently predict complications. RESULTS: Of 37, 999 cases that captured all ESS variables, 14, 446 (38%) resulted in at least one 30-day complication. The observed probability of a 30-day complication gradually increased from 7% to 53% to 91% at scores of 0, 7, and 15, respectively, with a c-statistic of 0.78. For ESS >15, the complication rate plateaued at a mean of 92%. On multivariable analyses, each of the 22 ESS components independently predicted the occurrence of postoperative complications. CONCLUSIONS: ESS reliably predicts postoperative complications in ES patients. Such a score could prove useful for (1) perioperative patient and family counseling and (2) benchmarking the quality of ES care. LEVEL OF EVIDENCE: Prognostic, level III.