The Urgent Surgery Elderly Mortality risk score: a simple mortality score

Area of Science:

• Geriatric Surgery
• Surgical Outcomes Research
• Clinical Risk Prediction

Background:

• Elderly patients undergoing urgent abdominal surgery face elevated mortality risks.
• Identifying mortality predictors is crucial for this vulnerable population.

Purpose of the Study:

• To identify factors associated with 30-day mortality in elderly patients undergoing urgent abdominal surgery.
• To develop a predictive scoring tool, the Urgent Surgery Elderly Mortality risk score (USEM score).

Main Methods:

• Retrospective analysis of a prospective database including patients over 65 undergoing urgent abdominal surgery.
• Multivariate regression analysis identified risk factors and assigned weights.
• Receiver operating characteristic (ROC) curves and the Hosmer-Lemeshow test assessed model performance.

Main Results:

• The study included 4,255 patients with an 8.5% mortality rate.
• Significant mortality predictors included American Society of Anesthesiologists (ASA) score, age, preoperative diagnosis (e.g., intestinal ischemia), wound classification, and surgical approach (open vs. laparoscopic).
• The developed USEM score demonstrated good predictive ability (AUROC 0.84).

Conclusions:

• A simple, five-variable scoring tool effectively predicts 30-day mortality in elderly patients undergoing urgent abdominal surgery.
• The USEM score can assist surgeons in the initial risk assessment of these high-risk patients.