TY - JOUR
T1 - The emergency surgery score (ESS) and outcomes in elderly patients undergoing emergency laparotomy
T2 - A post-hoc analysis of an EAST multicenter study
AU - El Hechi, Majed
AU - Kongkaewpaisan, Napaporn
AU - El Moheb, Mohamad
AU - Aicher, Brittany
AU - Diaz, Jose
AU - OʼMeara, Lindsay
AU - Decker, Cassandra
AU - Rodriquez, Jennifer
AU - Schroeppel, Thomas
AU - Rattan, Rishi
AU - Vasileiou, Georgia
AU - Yeh, D. Dante
AU - Simonosk, Ursula
AU - Turay, David
AU - Cullinane, Daniel
AU - Emmert, Cory
AU - McCrum, Marta
AU - Wall, Natalie
AU - Badach, Jeremy
AU - Goldenberg-Sanda, 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
N1 - Publisher Copyright:
© 2020
PY - 2021/5
Y1 - 2021/5
N2 - 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.
AB - 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.
KW - Elderly
KW - Emergency surgery
KW - Emergency surgery score
KW - Postoperative mortality
KW - Risk prediction
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U2 - 10.1016/j.amjsurg.2020.08.039
DO - 10.1016/j.amjsurg.2020.08.039
M3 - Article
C2 - 32917366
AN - SCOPUS:85090481391
SN - 0002-9610
VL - 221
SP - 1069
EP - 1075
JO - American journal of surgery
JF - American journal of surgery
IS - 5
ER -