The Emergency Surgery Score (ESS) Accurately Predicts the Need for Post-Discharge Respiratory and Renal Support after Emergent Laparotomies: A Prospective Multicenter Study
*Majed El Hechi, *Napaporn Kongkaewpaisan, *Leon Naar, Haytham M.A. Kaafarani
The EAST-ESS Collaborative Massachusetts General Hospital, Harvard Medical School, Boston, MA
Objective: 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). Design: Prospective observational study. Setting: Admissions for EL across 19 centers between April 2018 and June 2019. Patients: Adult patients undergoing EL. Patients were excluded if they died during index hospitalization, were discharged to hospice, or transferred to other hospitals. Intervention(s): N/A Main outcome measure(s): Examine the correlation between ESS and post-discharge RRS. Results: From a total of 1,649 patients, 1,347 were included. Median age was 60 years, 49.4% were male, and 71.4% were white. The most common diagnoses were hollow viscus perforation (28.1%) and small bowel obstruction (24.5%); 122 patients (9.1%) had a need for RRS (4.7% tracheostomy, 5.2% oxygen therapy, 2.7% dialysis and 1.3% ventilator dependence). ESS predicted the need for RRS in a stepwise fashion; for example, 1.5%, 23.5%, and 85.7% of patients required RRS at an ESS of 2, 10, and 16, respectively. The c-statistics for the need for RRS, the need for tracheostomy, oxygen therapy, ventilator dependence, or dialysis at discharge were 0.82, 0.82, 0.79, 0.79, and 0.88 respectively. Conclusions: ESS accurately predicts the need for RRS at discharge in EL patients and could be used for pre-operative patient counseling and for quality of care benchmarking. 
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