Emergency Surgery Mortality (ESM) Score to Predict Mortality and Improve Patient Care in Emergency Surgery

Abstract

Background Emergency surgery has poor outcomes with high mortality. Numerous studies have reported the risk factors for postoperative death in order to stratify risk and improve perioperative care; nevertheless, a predictive model based upon these risk factors is lacking. Objective We aimed to identify the risk factors of postoperative mortality and to construct a new model for predicting mortality and improving patient care. Methods We included adult patients undergoing emergency surgery at Srinagarind Hospital between January 2012 and December 2014. The patients were randomized: 80% to the Training group for model construction and 20% to the Validation group. Patient data were extracted from medical records and then analyzed using univariate and multivariate logistic regression. Results We recruited 758 patients, and the mortality rate was 14.5%. The Training group comprised 596 patients, and the Validation group comprised 162. Based upon a multivariate analysis in the Training group, we constructed a model to predict postoperative mortality—an Emergency Surgery Mortality (ESM) score based on the coefficient of each risk factor from the multivariate analysis. The ESM score comprised 7 risk factors, i.e., coagulopathy, ASA class 5, bicarbonate <15 mEq/L, heart rate >100/min, systolic blood pressure <90 mmHg, renal comorbidity, and general surgery, for a total score of 11. An ESM score ≥4 was predictive of postoperative mortality with an AUC of 0.83. The respective sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, and accuracy for an ESM score ≥4 predictive of postoperative mortality was 70.2%, 94.9%, 13.8, 0.3, 69.4%, 95.1%, and 91.4%. The performance of the ESM score in the Validation group was comparable. Conclusions An ESM score comprises 7 risk factors for a total score of 11. An ESM score ≥4 is predictive of postoperative mortality with a high AUC (0.83), sensitivity (70.2%), and specificity (94.9%). Four risk factors are preoperatively manageable for decreasing the probability of postoperative mortality and improving quality of patient care.

Staged laparotomy for acute non‐traumatic intra‐abdominal emergencies in a tertiary South African unit

“…4 Despite these differences, there have been a number of reports on the use of abbreviated/staged approaches in EGS. [5][6][7] Most of these reports are small case series and include a heterogenous cohort of surgical principles and approaches. The level of evidence to support SL for EGS is low and there is little consensus as to what should constitute a staged approach to the critically ill EGS patient.…”

“…The age of trauma and EGS patients is often different as is the spectrum of comorbidities 4 . Despite these differences, there have been a number of reports on the use of abbreviated/staged approaches in EGS 5–7 . Most of these reports are small case series and include a heterogenous cohort of surgical principles and approaches.…”