Can the emergency surgery score (ESS) be used as a triage tool predicting the postoperative need for an ICU admission?

American Journal of Surgery
Napaporn KongkaewpaisanHaytham M A Kaafarani

Abstract

The emergency surgery score (ESS) is a preoperative risk calculator recently validated as a mortality predictor in emergency surgery (ES) patients. We sought to evaluate the utility of ESS as an ICU admission triage tool. A four-step methodology was designed. First, the 2007-2015 ACS-NSQIP database was examined to identify all ES patients using the "emergent" variable and CPT codes for "digestive system". Second, we created a composite variable called ICUneed, defined as death or the development of one or more postoperative complication warranting critical care (e.g. unplanned intubation, ventilator dependent ≥48 h, cardiac arrest, septic shock and coma ≥24 h). Third, for each patient, ESS was calculated. Fourth, the correlation between ESS and ICUneed was assessed by calculating the model c-statistics (AUROC). Out of a total of 4,456,809 patients, 65,989 patients were included. The mean population age was 56 years; 51% were female, and 71% were white. The overall 30-day postoperative mortality and morbidity were 8.2% and 31.7%, respectively. ESS gradually and accurately predicted ICUneed, with 1%, 40% and 98% of patients with ESS of 2, 9 and 16 requiring critical care, respectively. Only 6.2% of patients with ESS ≤7 had an ICU...Continue Reading

Citations

May 30, 2020·The Journal of Trauma and Acute Care Surgery·Marta L McCrumMarie L Crandall
Jan 12, 2021·The Journal of Surgical Research·Apostolos GaitanidisHaytham M A Kaafarani
Jan 25, 2021·American Journal of Surgery·Paul D RozeboomRobert A Meguid
Oct 16, 2020·The Journal of Trauma and Acute Care Surgery·Reem AlSowaieghHaytham M A Kaafarani
Mar 24, 2021·The Journal of Trauma and Acute Care Surgery·Lydia R MaurerHaytham M A Kaafarani
Jul 24, 2021·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Chrysanthos Dimitris ChristouHaytham Mohamed Ali Kaafarani
Jul 16, 2021·Annals of Surgery·Tyler J LoftusAzra Bihorac

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