DOES THE EMERGENCY SURGERY SCORE PREDICT FAILURE TO DISCHARGE THE PATIENT HOME? A NATIONWIDE ANALYSIS & THE EMERGENCY SURGERY SCORE IS A POWERFUL PREDICTOR OF OUTCOMES ACROSS MULTIPLE SURGICAL SPECIALTIES: RESULTS OF A RETROSPECTIVE NATIONWIDE ANALYSIS
AlSowaiegh, Reem Mohammed
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CitationAlSowaiegh, Reem Mohammed. 2021. DOES THE EMERGENCY SURGERY SCORE PREDICT FAILURE TO DISCHARGE THE PATIENT HOME? A NATIONWIDE ANALYSIS & THE EMERGENCY SURGERY SCORE IS A POWERFUL PREDICTOR OF OUTCOMES ACROSS MULTIPLE SURGICAL SPECIALTIES: RESULTS OF A RETROSPECTIVE NATIONWIDE ANALYSIS. Master's thesis, Harvard Medical School.
BACKGROUND:The Emergency Surgery Score (ESS) is a point-based scoring system validated to predict mortality and morbidity in emergency general surgery (EGS). In addition to demographics and comorbidities, ESS accounts for the acuity of disease at presentation. We sought to examine whether ESS can predict the destination of discharge of EGS patients, as a proxy for quality of life at discharge.
METHODS: Using the 2007 to 2017 American College of Surgeons National Surgical Quality Improvement Program database, we identified all EGS patients. EGS cases were defined as per American College of Surgeons National Surgical Quality Improvement Program as those performed by a general surgeon within a short interval from diagnosis or the onset of related symptomatology, when the patient’s well-being and outcome may be threatened by unnecessary delay and patient’s status could deteriorate unpredictably or rapidly. Emergency Surgery Score patients were then categorized by their discharge disposition to home versus rehabilitation or nursing facilities. All patients with missing ESS or discharge disposition and those discharged to hospice, senior communities, or separate acute care facilities were excluded. Emergency Surgery Score was calculated for each patient. C statistics were used to study the correlation between ESS and the destination of discharge.
RESULTS: Of 6,485,915 patients, 84,694 were included. The mean age was 57 years, 51% were female, and 79.6% were discharged home. The mean ESS was 5. Emergency Surgery Score accurately and reliably predicted the discharge destination with a C statistic of 0.83. For example, ESS of 1, 10, and 20 were associated with 0.9%, 56.5%, and 100% rates of discharge to a rehabilitation or nursing facility instead of home.
CONCLUSION: Emergency Surgery Score accurately predicts which EGS patients require discharge to rehabilitation or nursing facilities and can thus be used for preoperatively counseling patients and families and for improving early discharge preparations, when appropriate.
Background: The Emergency Surgery Score (ESS) was recently validated in a prospective multicenter study as an accurate predictor of mortality in Emergency General Surgery (EGS) patients. ESS is easily calculated using multiple demographics, comorbidities, laboratory, and acuity of disease variables. We aimed to investigate whether ESS can predict 30-day postoperative mortality across patients undergoing emergency surgery in multiple surgical specialties.
Methods: Our study is a retrospective cohort study using data from the national ACS-NSQIP database (2007-2017). 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.
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), and moderately well in emergency thoracic, neurosurgical, orthopedic, and vascular surgery (C-statistics 0.73-0.79). For example, the mortality of gynecology patients with ESS of 5, 9 and 13 was 2%, 27%, and 50%, respectively. ESS performed poorly in cardiac surgery.
Conclusion: ESS accurately predicts mortality across patients undergoing emergency surgery in 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.
Citable link to this pagehttps://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37368018