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The Emergency Surgery Score accurately predicts the need for postdischarge respiratory and renal support after
Majed El Hechi1, Napaporn Kongkaewpaisan, Leon Naar
1From the Division of Trauma, Emergency Surgery & Surgical Critical Care (M.E.H., N.K., L.N., H.M.A.K.), Massachusetts General Hospital, Boston, Massachusetts; Division of Acute Care and Ambulatory Surgery (N.K.), Siriraj Hospital, Mahidol University, Bangkok, Thailand; R Adams Cowley Shock Trauma Center (B.A., J.D., L.O.), University of Maryland Medical Center, Baltimore, Maryland; Department of Surgery, UCHealth Memorial Hospital Central Trauma Center (C.D., J.R., T.S.), Colorado Springs, Colorado; The Dewitt Daughtry Family Department of Surgery Ryder Trauma Center/Jackson Memorial Hospital (R.R., G.V., D.D.Y.), Miami, Florida; Department of Surgery, Loma Linda University Medical Center (U.S., D.T.), Department of Surgery, Loma Linda, California; Marshfield Clinic (D.C., C.E.), Marshfield, Wisconsin; University of Utah (M.C., N.W.), Salt Lake City, Utah; Department of Surgery, Cooper University Hospital (J.B., A.G.-S.), Camden, New Jersey; Department of Surgery, University of Colorado Anschutz Medical Campus (H.C., C.V.), Aurora, Colorado; Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins University School of Medicine (R.C., J.S.), Baltimore, Maryland; Department of Surgery, Eastern Maine Medical Center (K.B.), Bangor, Maine; Department of Surgery, University of Texas Southwestern Medical Center and Parkland Hospital (G.B., T.S.), Dallas, Texas; Department of Surgery, Staten Island University Hospital, Northwell Health (Z.C., V.S.), Staten Island, New York; Department of Surgery, University of Florida College of Medicine-Jacksonville (F.M., D.S.), Jacksonville, Florida; Mayo Clinic (M.C., M.Z.), Rochester, Minnesota; Miami Valley Hospital (C.H., M.W.), Dayton, Ohio; New York University School of Medicine (M.K., S.R.), New York, New York; Department of Surgery, Papageorgiou General Hospital/Aristotle University School of Medicine (V.P., G.T.), Greece; and Department of Surgery, Hackensack University Medical Center (J.P.), Hackensack, New Jersey.
Background:
The Emergency Surgery Score (ESS) was recently validated as an accurate mortality risk calculator for emergency general surgery. We sought to prospectively evaluate whether ESS can predict the need for respiratory and/or renal support (RRS) at discharge after emergent laparotomies (EL).
Methods:
This is a post hoc analysis of a 19-center prospective observational study. Between April 2018 and June 2019, all adult patients undergoing EL were enrolled. Preoperative, intraoperative, and postoperative variables were systematically collected. In this analysis, patients were excluded if they died during the index hospitalization, were discharged to hospice, or transferred to other hospitals. A composite variable, the need for RRS, was defined as the need for one or more of the following at hospital discharge: tracheostomy, ventilator dependence, or dialysis. Emergency Surgery Score was calculated for all patients, and the correlation between ESS and RRS was examined using the c-statistics method.
Results:
From a total of 1,649 patients, 1,347 were included. Median age was 60 years, 49.4% were men, and 70.9% were White. The most common diagnoses were hollow viscus organ perforation (28.1%) and small bowel obstruction (24.5%); 87 patients (6.5%) had a need for RRS (4.7% tracheostomy, 2.7% dialysis, and 1.3% ventilator dependence). Emergency Surgery Score predicted the need for RRS in a stepwise fashion; for example, 0.7%, 26.2%, and 85.7% of patients required RRS at an ESS of 2, 12, and 16, respectively. The c-statistics for the need for RRS, the need for tracheostomy, ventilator dependence, or dialysis at discharge were 0.84, 0.82, 0.79, and 0.88, respectively.
Conclusion:
Emergency Surgery Score accurately predicts the need for RRS at discharge in EL patients and could be used for preoperative patient counseling and for quality of care benchmarking.
Level Of Evidence:
Prognostic and epidemiological, level III.
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