Publication:
Prospective validation of the Emergency Surgery Score in emergency general surgery: An Eastern Association for the Surgery of Trauma multicenter study

Issued Date

2020-07-01

Resource Type

Conference Paper

ISSN

21630763
21630755

DOI

10.1097/TA.0000000000002658

Other identifier(s)

2-s2.0-85079847380

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Journal of Trauma and Acute Care Surgery. Vol.89, No.1 (2020), 118-124

Suggested Citation

Haytham M.A. Kaafarani, Napaporn Kongkaewpaisan, Brittany O. Aicher, Jose J. Diaz, Lindsay B. O'Meara, Cassandra Decker, Jennifer Rodriquez, Thomas Schroeppel, Rishi Rattan, Georgia Vasileiou, D. Dante Yeh, Ursula J. Simonoski, David Turay, Daniel C. Cullinane, Cory B. Emmert, Marta L. McCrum, Natalie Wall, Jeremy Badach, Anna Goldenberg-Sandau, Heather Carmichael, Catherine Velopulos, Rachel Choron, Joseph V. Sakran, Khaldoun Bekdache, George Black, Thomas Shoultz, Zachary Chadnick, Vasiliy Sim, Firas Madbak, Daniel Steadman, Maraya Camazine, Martin D. Zielinski, Claire Hardman, Mbaga Walusimbi, Mirhee Kim, Simon Rodier, Vasileios N. Papadopoulos, Georgios Tsoulfas, Javier Martin Perez, George C. Velmahos Prospective validation of the Emergency Surgery Score in emergency general surgery: An Eastern Association for the Surgery of Trauma multicenter study. Journal of Trauma and Acute Care Surgery. Vol.89, No.1 (2020), 118-124. doi:10.1097/TA.0000000000002658 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/58117

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Title

Prospective validation of the Emergency Surgery Score in emergency general surgery: An Eastern Association for the Surgery of Trauma multicenter study

Author(s)

Haytham M.A. Kaafarani
 Napaporn Kongkaewpaisan
 Brittany O. Aicher
 Jose J. Diaz
 Lindsay B. O'Meara
 Cassandra Decker
 Jennifer Rodriquez
 Thomas Schroeppel
 Rishi Rattan
 Georgia Vasileiou
 D. Dante Yeh
 Ursula J. Simonoski
 David Turay
 Daniel C. Cullinane
 Cory B. Emmert
 Marta L. McCrum
 Natalie Wall
 Jeremy Badach
 Anna Goldenberg-Sandau
 Heather Carmichael
 Catherine Velopulos
 Rachel Choron
 Joseph V. Sakran
 Khaldoun Bekdache
 George Black
 Thomas Shoultz
 Zachary Chadnick
 Vasiliy Sim
 Firas Madbak
 Daniel Steadman
 Maraya Camazine
 Martin D. Zielinski
 Claire Hardman
 Mbaga Walusimbi
 Mirhee Kim
 Simon Rodier
 Vasileios N. Papadopoulos
 Georgios Tsoulfas
 Javier Martin Perez
 George C. Velmahos

Other Contributor(s)

Loma Linda University Medical Center
 Massachusetts General Hospital
 Marshfield Clinic
 University of Colorado at Denver Anschutz Medical Campus
 UT Southwestern Medical Center
 Eastern Maine Medical Center
 The University of Utah
 NYU Grossman School of Medicine
 Memorial Hospital Central
 Staten Island University Hospital
 Cooper University Hospital
 Hackensack University Medical Center
 Aristotle University of Thessaloniki
 University of Maryland R Adams Cowley Shock Trauma Center
 Faculty of Medicine, Siriraj Hospital, Mahidol University
 Miami Valley Hospital
 University of Florida College of Medicine
 Mayo Clinic
 Jackson Memorial Hospital
 Harvard Medical School
 Johns Hopkins School of Medicine

Abstract

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. BACKGROUND The Emergency Surgery Score (ESS) was recently developed and retrospectively validated as an accurate mortality risk calculator for emergency general surgery. We sought to prospectively validate ESS, specifically in the high-risk nontrauma emergency laparotomy (EL) patient. METHODS This is an Eastern Association for the Surgery of Trauma multicenter prospective observational study. Between April 2018 and June 2019, 19 centers enrolled all adults (aged >18 years) undergoing EL. Preoperative, intraoperative, and postoperative variables were prospectively and systematically collected. Emergency Surgery Score was calculated for each patient and validated using c-statistic methodology by correlating it with three postoperative outcomes: (1) 30-day mortality, (2) 30-day complications (e.g., respiratory/renal failure, infection), and (3) postoperative intensive care unit (ICU) admission. RESULTS A total of 1,649 patients were included. The mean age was 60.5 years, 50.3% were female, and 71.4% were white. The mean ESS was 6, and the most common indication for EL was hollow viscus perforation. The 30-day mortality and complication rates were 14.8% and 53.3%; 57.0% of patients required ICU admission. Emergency Surgery Score gradually and accurately predicted 30-day mortality; 3.5%, 50.0%, and 85.7% of patients with ESS of 3, 12, and 17 died after surgery, respectively, with a c-statistic of 0.84. Similarly, ESS gradually and accurately predicted complications; 21.0%, 57.1%, and 88.9% of patients with ESS of 1, 6, and 13 developed postoperative complications, with a c-statistic of 0.74. Emergency Surgery Score also accurately predicted which patients required intensive care unit admission (c-statistic, 0.80). CONCLUSION This is the first prospective multicenter study to validate ESS as an accurate predictor of outcome in the EL patient. Emergency Surgery Score can prove useful for (1) perioperative patient and family counseling, (2) triaging patients to the intensive care unit, and (3) benchmarking the quality of emergency general surgery care. LEVEL OF EVIDENCE Prognostic study, level III.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/58117

Collections

Scopus 2020