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

被引：32

作者：

Kaafarani, Haytham M. A. ^{[1
,2
]}

Kongkaewpaisan, Napaporn ^{[1
,3
]}

Aicher, Brittany O. ^{[4
]}

Diaz, Jose J., Jr. ^{[4
]}

O'Meara, Lindsay B. ^{[4
]}

Decker, Cassandra ^{[5
]}

Rodriquez, Jennifer ^{[5
]}

Schroeppel, Thomas ^{[5
]}

Rattan, Rishi ^{[6
]}

Vasileiou, Georgia ^{[6
]}

Yeh, D. Dante ^{[6
]}

Simonoski, Ursula J. ^{[7
]}

Turay, David ^{[7
]}

Cullinane, Daniel C. ^{[8
]}

Emmert, Cory B. ^{[8
]}

McCrum, Marta L. ^{[9
]}

Wall, Natalie ^{[9
]}

Badach, Jeremy ^{[10
]}

Goldenberg-Sandau, Anna ^{[10
]}

Carmichael, Heather ^{[11
]}

Velopulos, Catherine ^{[11
]}

Choron, Rachel ^{[12
]}

Sakran, Joseph V. ^{[12
]}

Bekdache, Khaldoun ^{[13
]}

Black, George ^{[14
,15
]}

Shoultz, Thomas ^{[14
,15
]}

Chadnick, Zachary ^{[16
]}

Sim, Vasiliy ^{[16
]}

Madbak, Firas ^{[17
]}

Steadman, Daniel ^{[17
]}

Camazine, Maraya ^{[18
]}

Zielinski, Martin D. ^{[18
]}

Hardman, Claire ^{[19
]}

Walusimbi, Mbaga ^{[19
]}

Kim, Mirhee ^{[20
]}

Rodier, Simon ^{[20
]}

Papadopoulos, Vasileios N. ^{[21
]}

Tsoulfas, Georgios ^{[21
]}

Perez, Javier Martin ^{[22
]}

Velmahos, George C. ^{[1
]}

机构：

[1] Massachusetts Gen Hosp, Div Trauma Emergency Surg & Surg Crit Care, 165 Cambridge St,Suite 810, Boston, MA 02114 USA

[2] Harvard Med Sch, 25 Shattuck St, Boston, MA 02115 USA

[3] Mahidol Univ, Siriraj Hosp, Div Acute Care & Ambulatory Surg, Bangkok, Thailand

[4] Univ Maryland, Dept Surg, Med Ctr, R Adams Cowley Shock Trauma Ctr, Baltimore, MD 21201 USA

[5] UCHlth Mem Hosp, Cent Trauma Ctr, Dept Surg, Colorado Springs, CO USA

[6] Jackson Mem Hosp, Dewitt Daughtry Family Dept Surg, Ryder Trauma Ctr, Miami, FL 33136 USA

[7] Loma Linda Univ, Med Ctr, Dept Surg, Loma Linda, CA USA

[8] Marshfield Clin Fdn Med Res & Educ, Dept Surg, Marshfield, WI USA

[9] Univ Utah, Dept Surg, Salt Lake City, UT USA

[10] Cooper Univ Hosp, Dept Surg, Camden, NJ USA

[11] Univ Colorado Anschutz Med Campus, Dept Surg, Aurora, CO USA

[12] Johns Hopkins Univ, Sch Med, Dept Surg, Div Acute Care Surg, Baltimore, MD 21205 USA

[13] Eastern Maine Med Ctr, Dept Surg, Bangor, ME USA

[14] Univ Texas Southwestern Med Ctr, Dept Surg, Dallas, TX USA

[15] Parkland Hosp, Dallas, TX USA

[16] Staten Isl Univ Hosp, Northwell Hlth, Dept Surg, Staten Isl, NY USA

[17] Univ Florida, Coll Med, Dept Surg, Jacksonville, FL USA

[18] Mayo Clin, Dept Surg, Rochester, MN USA

[19] Miami Valley Hosp, Dept Surg, Dayton, OH USA

[20] NYU, Dept Surg, Sch Med, New York, NY 10016 USA

[21] Aristotle Univ Thessaloniki, Papageorgiou Gen Hosp, Sch Med, Thessaloniki, Greece

[22] Hackensack Univ, Dept Surg, Med Ctr, Hackensack, NJ USA

来源：

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY | 2020年 / 89卷 / 01期

关键词：

Emergency Surgery Score; postoperative mortality; postoperative complications; emergency surgery; quality benchmarking; PREDICTING POSTOPERATIVE COMPLICATIONS; ACUTE-CARE SURGERY; ACCURATELY PREDICTS; RISK CALCULATOR; OUTCOMES; MORTALITY; BURDEN;

D O I：

10.1097/TA.0000000000002658

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

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 patientswere included. The mean agewas 60.5 years, 50.3% were female, and 71.4% werewhite. The mean ESSwas 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. Copyright (C) 2020 Wolters Kluwer Health, Inc. All rights reserved.

引用

页码：118 / 124

页数：7

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