Does the emergency surgery score accurately predict outcomes in emergent laparotomies?

Peponis, Thomas; Bohnen, Jordan D.; Sangji, Naveen F.; Nandan, Anirudh R.; Han, Kelsey; Lee, Jarone; Yeh, D. Dante; Moya, Marc A. de; Velmahos, George C.; Chang, David C.; Kaafarani, Haytham M.A.

doi:10.1016/j.surg.2017.03.016

Cited by 39 publications

(55 citation statements)

References 27 publications

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“…In addition, the 30-day post-operative mortality was only reported in 12 of the 22 identified studies. 16,18,19,21,22,25,[28][29][30][31]33,34 A meta-analysis of results was not possible due to the heterogeneity of data reporting and study methodology. The following identified preoperative variables describe the relative increases in post-operative mortality for patients having an EL.…”

Section: Resultsmentioning

confidence: 99%

“…30 Functional dependency status Four studies explored the relationship between patient functional status and mortality following EL. 17,19,29,30 A statistically significant increase in mortality for patients who were totally dependent or bed-bound was observed in all of these studies, inclusive of the largest study by Haskins et al However, when patients were partially (carer) dependent, two studies demonstrated an increase in mortality, although only the larger of these studies, by Al-Temimi et al, demonstrated this increase to be statistically significant (Table S3). 17,19 DNR status Do-not-resuscitate (DNR) status refers to whether a DNR form was signed for the patient prior to their operation.…”

Section: Preoperative Sepsismentioning

confidence: 91%

“…Increasing age is associated with increased mortality in 11 studies on multivariate analysis 15,18,19,22,26,[28][29][30][31]33,34 (Table S2).…”

Section: Agementioning

confidence: 99%

“…The presence of chronic obstructive pulmonary disease increased post-operative mortality in five studies. 17,19,21,29,30 Preoperative dyspnoea increased the risk for mortality in two studies. 19,30 However, smoking status was not associated with mortality in two out of three studies (Table S4).…”

Section: Respiratorymentioning

confidence: 99%

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Risk factors for mortality after emergency laparotomy: scoping systematic review

Barazanchi

Xia

MacFater

et al. 2020

ANZ Journal of Surgery

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Background: Emergency laparotomy (EL) is a common procedure with high mortality leading to several efforts to record and reduce mortality. Risk scores currently used by quality improvement programmes either require intraoperative data or are not specific to EL. To be of utility to clinicians/patients, estimation of preoperative risk of mortality is important. We aimed to explore individual preoperative risk factors that might be of use in developing a preoperative mortality risk score. Methods: Two independent reviewers identified relevant articles from searches of MEDLINE, EMBASE and Cochrane databases from January 1980 to January 2018. We selected studies that evaluated only preoperative predictive factors for mortality in EL patients. Results: The search yielded 6648 articles screened, with 22 studies included examining 157 728 patients. The combined post-operative 30-day mortality was 13%. All, but one small study, were at low risk of bias. A meta-analysis of results was not possible due to the heterogeneity of populations and outcomes. Age, American Society of Anesthesiologists, preoperative sepsis, dependency status, current cancer and comorbidities were associated with increased mortality. Acute physiological derangements seen in renal, albumin and complete blood count assays were strongly associated with mortality. Delay to surgery and diabetes did not influence mortality. Higher body mass index was protective. Conclusion: Preoperatively, risk factors identified can be used to develop and update risk scores specific for EL mortality. This scoping review focused on the preoperative setting which helps tailor treatment decisions. It highlights the need for further research to test the relevance of newer risk factors such as frailty and nutrition.

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Section: Resultsmentioning

confidence: 99%

Section: Preoperative Sepsismentioning

confidence: 91%

“…Increasing age is associated with increased mortality in 11 studies on multivariate analysis 15,18,19,22,26,[28][29][30][31]33,34 (Table S2).…”

Section: Agementioning

confidence: 99%

Section: Respiratorymentioning

confidence: 99%

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Risk factors for mortality after emergency laparotomy: scoping systematic review

Barazanchi

Xia

MacFater

et al. 2020

ANZ Journal of Surgery

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“…Haydar et al [90] warned that qSOFA alone more than doubles the time to identify sepsis in the emergency room compared with SIRS screening criteria and may even delay the initiation of therapy for sepsis, thus worsening outcomes. In the emergency surgery patient, the Emergency Surgery Score (ESS) calculated pre-operatively has been shown to predict post-operative outcome accurately including post-operative sepsis (Table 2) [ [91][92][93]. In the last few years, the use of artificial intelligence has been promising.…”

Section: Predicting Sepsismentioning

confidence: 99%

Sepsis 2019: What Surgeons Need to Know

Kaafarani

Rattan

et al. 2020

Surgical Infections

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The definition of sepsis continues to be as dynamic as the management strategies used to treat this. Sepsis-3 has replaced the earlier systemic inflammatory response syndrome (SIRS)-based diagnoses with the rapid Sequential Organ Failure Assessment (SOFA) score assisting in predicting overall prognosis with regards to mortality. Surgeons have an important role in ensuring adequate source control while recognizing the threat of carbapenem-resistance in gram-negative organisms. Rapid diagnostic tests are being used increasingly for the early identification of multi-drug-resistant organisms (MDROs), with a key emphasis on the multidisciplinary alert of results. Novel, higher generation antibiotic agents have been developed for resistance in ESKCAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) organisms while surgeons have an important role in the prevention of spread. The Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial has challenged the previous paradigm of length of antibiotic treatment whereas biomarkers such as procalcitonin are playing a prominent role in individualizing therapy. Several novel therapies for refractory septic shock, while still investigational, are gaining prominence rapidly (such as vitamin C) whereas others await further clinical trials. Management strategies presented as care bundles continue to be updated by the Surviving Sepsis Campaign, yet still remain controversial in its global adoption. We have broadened our temporal and epidemiologic perspective of sepsis by understanding it both as an acute, time-sensitive, life-threatening illness to a chronic condition that increases the risk of mortality up to five years post-discharge. Artificial intelligence, machine learning, and bedside scoring systems can assist the clinician in predicting post-operative sepsis. The public health role of the surgeon is key. This includes collaboration and multidisciplinary antibiotic stewardship at a hospital level. It also requires controlling pharmaceutical sales and the unregulated dispensing of antibiotic agents globally through policy initiatives to control emerging resistance through prevention.

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