TY - JOUR
T1 - The Emergency Surgery Score accurately predicts the need for postdischarge respiratory and renal support after emergent laparotomies
T2 - A prospective EAST multicenter study
AU - El Hechi, Majed
AU - Kongkaewpaisan, Napaporn
AU - Naar, Leon
AU - Aicher, Brittany
AU - Diaz, Jose
AU - O’Meara, Lindsay
AU - Decker, Cassandra
AU - Rodriquez, Jennifer
AU - Schroeppel, Thomas
AU - Rattan, Rishi
AU - Vasileiou, Georgia
AU - Yeh, D. Dante
AU - Simonoski, Ursula
AU - Turay, David
AU - Cullinane, Daniel
AU - Emmert, Cory
AU - McCrum, Marta
AU - Wall, Natalie
AU - Badach, Jeremy
AU - Goldenberg-Sandau, Anna
AU - Carmichael, Heather
AU - Velopulos, Catherine
AU - Choron, Rachel
AU - Sakran, Joseph
AU - Bekdache, Khaldoun
AU - Black, George
AU - Shoultz, Thomas
AU - Chadnick, Zachary
AU - Sim, Vasiliy
AU - Madbak, Firas
AU - Steadman, Daniel
AU - Camazine, Maraya
AU - Zielinski, Martin
AU - Hardman, Claire
AU - Walusimbi, Mbaga
AU - Kim, Mirhee
AU - Rodier, Simon
AU - Papadopoulos, Vasileios
AU - Tsoulfas, Georgios
AU - Perez, Javier
AU - Kaafarani, Haytham M.A.
N1 - Funding Information:
We thank Xian Luo-Owen, MD, PhD, Janika San Roman, MPH, CCRP, Martin Moe, MS, Shane Urban, BSN, RN, Marko Bukur, MD, Tala Kana’an, MD, Christou Chrysanthos and Alexandros Tsolakidis for their data contribution.
Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
KW - Emergency Surgery Score
KW - dialysis
KW - discharge
KW - tracheostomy
KW - ventilator
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U2 - 10.1097/TA.0000000000003016
DO - 10.1097/TA.0000000000003016
M3 - Article
C2 - 33507026
AN - SCOPUS:85102217368
SN - 2163-0755
VL - 90
SP - 557
EP - 564
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 3
ER -