The emergency surgery score (ESS) and outcomes in elderly patients undergoing emergency laparotomy: A post-hoc analysis of an EAST multicenter study |
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| Authors: | Majed El Hechi Napaporn Kongkaewpaisan Mohamad El Moheb Brittany Aicher Jose Diaz Lindsay OʼMeara Cassandra Decker Jennifer Rodriquez Thomas Schroeppel Rishi Rattan Georgia Vasileiou D. Dante Yeh Ursula Simonosk David Turay Daniel Cullinane Cory Emmert Marta McCrum Natalie Wall Haytham Kaafarani |
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| Affiliation: | 1. Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA;2. Division of Acute Care and Ambulatory Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand;3. R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA;4. UCHealth Memorial Hospital Central Trauma Center, Colorado Springs, CO, USA;5. The DeWitt Daughtry Family Department of Surgery Ryder Trauma Center/ Jackson Memorial Hospital, Miami, FL, USA;6. Loma Linda University Medical Center, Loma Linda, CA, USA;7. Marshfield Clinic, Marshfield, WI, USA;8. University of Utah, Salt Lake City, UT, USA;9. Cooper University Hospital, Camden, NJ, USA;10. University of Colorado Anschutz Medical Campus, Aurora, CO, USA;11. The Johns Hopkins University School of Medicine, Baltimore, MD, USA;12. Eastern Maine Medical Center, Bangor, ME, USA;13. University of Texas Southwestern Medical Center and Parkland Hospital, Dallas, TX, USA;14. Staten Island University Hospital, Northwell Health, Staten Island, NY, USA;15. University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA;p. Mayo Clinic, Rochester, MN, USA;q. Miami Valley Hospital, Dayton, OH, USA;r. New York University School of Medicine, New York, NY, USA;s. Papageorgiou General Hospital/Aristotle University School of Medicine, Thessaloniki, Greece;t. Hackensack University Medical Center, Hackensack, NJ, USA;1. Division of Surgical Oncology, Department of Surgery, Ohio State University Comprehensive Cancer Center and Ohio State University Wexner Medical Center, Columbus, OH, USA;2. School of Medicine and Public Health, University of Wisconsin-Madison, USA;3. Division of Surgical Oncology, Indiana University School of Medicine, Indianapolis, IN, USA;4. Moi Teaching and Referral Hospital, Eldoret, Kenya;5. Division of Endocrine Surgery, University of Wisconsin-Madison, USA;1. University of Utah, School of Medicine, United States;2. University of Utah, Department of Surgery, Division of Urology, United States;3. Houston Methodist Hospital, Department of Surgery, United States;4. University of Illinois at Chicago, College of Medicine, United States;5. University of Utah, Department of Internal Medicine, Division of Epidemiology, United States;6. University of Utah, Department of Surgery, Division of Vascular Surgery, United States;1. Department of Surgery, University of Michigan, Ann Arbor, MI, USA;2. Center for Global Surgery, University of Michigan, Ann Arbor, MI, USA |
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| Abstract: | IntroductionWe sought to evaluate whether the Emergency Surgery Score (ESS) can accurately predict outcomes in elderly patients undergoing emergent laparotomy (EL).MethodsThis is a post-hoc analysis of an EAST multicenter study. Between April 2018 and June 2019, all adult patients undergoing EL in 19 participating hospitals were prospectively enrolled, and ESS was calculated for each patient. Using the c-statistic, the correlation between ESS and mortality, morbidity, and need for ICU admission was assessed in three patient age cohorts (65–74, 75–84, ≥85 years old).Results715 patients were included, of which 52% were 65–74, 34% were 75–84, and 14% were ≥85 years old; 51% were female, and 77% were white. ESS strongly correlated with postoperative mortality (c-statistic:0.81). Mortality gradually increased from 0% to 20%–60% at ESS of 2, 10 and 16 points, respectively. ESS predicted mortality, morbidity, and need for ICU best in patients 65–74 years old (c-statistic:0.81, 0.75, 0.83 respectively), but its performance significantly decreased in patients ≥85 years (c-statistic:0.72, 0.64, 0.67 respectively).ConclusionESS is an accurate predictor of outcome in the elderly EL patient 65–85 years old, but its performance decreases for patients ≥85. Consideration should be given to modify ESS to better predict outcomes in the very elderly patient population. |
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| Keywords: | Emergency surgery score Risk prediction Elderly Emergency surgery Postoperative mortality |
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