The emergency surgery score (ESS) and outcomes in elderly patients undergoing emergency laparotomy: A post-hoc analysis of an EAST multicenter study

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, Jeremy Badach, Anna Goldenberg-SandaHeather Carmichael, Catherine Velopulos, Rachel Choron, Joseph Sakran, Khaldoun Bekdache, George Black, Thomas Shoultz, Zachary Chadnick, Vasiliy Sim, Firas Madbak, Daniel Steadman, Maraya Camazine, Martin Zielinski, Claire Hardman, Mbaga Walusimbi, Mirhee Kim, Simon Rodier, Vasileios Papadopoulos, Georgios Tsoulfas, Javier Perez, Haytham Kaafarani

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: We sought to evaluate whether the Emergency Surgery Score (ESS) can accurately predict outcomes in elderly patients undergoing emergent laparotomy (EL). Methods: This 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). Results: 715 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). Conclusion: ESS 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.

Original languageEnglish (US)
JournalAmerican journal of surgery
DOIs
StateAccepted/In press - 2020

Keywords

  • Elderly
  • Emergency surgery
  • Emergency surgery score
  • Postoperative mortality
  • Risk prediction

ASJC Scopus subject areas

  • Surgery

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