New England Surgical Society

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The Emergency Surgery Score (ESS) is a Powerful Predictor of Outcome Across Multiple Surgical Specialties: A Nationwide Analysis
*Reem AlSowaiegh, *Leon Naar, *Mohamad El Moheb, *Jonathan Parks, *Jason Fawley, *April Mendoza, *Noelle Saillant, *George Velmahos, Haytham Kaafarani
Massachusetts General Hospital, Harvard Medical School, Boston, MA

Objective: The Emergency Surgery Score (ESS) was recently validated in a prospective multicenter study as an accurate predictor of mortality in emergency general surgery patients. ESS is easily calculated using multiple demographic, comorbidities, laboratory and acuity of disease variables. We aimed to investigate whether ESS can predict mortality across multiple surgical specialties.
Design: Retrospective nationwide cohort study. Setting: 2007-2017 ACS-NSQIP database.
Patients: We included patients that underwent emergency gynecological, urologic, thoracic, neurosurgical, orthopedic, vascular, cardiac and general surgical procedures. ESS was calculated for each patient, and the correlation between ESS and 30-day mortality was assessed for each specialty using the c-statistics methodology.
Interventions: N/A
Main Outcome Measures: 30-day postoperative mortality.
Results: Out of 6,485,915 patients, 173,890 patients were included. The mean age was 60 years, 50.6% were females, and the overall mortality was 9.7%. ESS predicted mortality best in emergency gynecological, general, and urological surgery (C-statistics: 0.97, 0.87, 0.81, respectively; Figure 1), and moderately well in emergency thoracic, neurosurgical, orthopedic and vascular surgery (c-statistics 0.73-0.79; Figure 2). For example, the mortality of gynecology patients with ESS of 5, 9 and 13 were 2%, 27%, and 50%, respectively. ESS performed poorly in cardiac surgery.
Conclusions: ESS accurately predicts mortality across multiple surgical specialties, especially general, gynecologic, and urologic surgery. ESS can prove useful for perioperative patient counseling and for benchmarking the quality of surgical care.


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