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Does the Emergency Surgery Acuity Score (ESAS) Accurately Predict Outcomes in Emergent Laparotomies?
Thomas Peponis, MD1, Jordan D. Bohnen, MD, MBA1, Naveen F. Sangji, MD, MPH1, Anirudh R. Nandan, BA1, Myriam Martinez, MD1, Kelsey Han1, Marc De Moya, MD1, George C. Velmahos, MD, PhD, FACS1, David C. Chang, MPH, MBA, PhD1,2 , Haytham M.A. Kaafarani, MD, MPH, FACS1 1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 2Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA
Background: The Emergency Surgery Acuity Score (ESAS) is a mortality-risk calculator for Emergency General Surgery patients. We examined whether ESAS predicts 30-day morbidity and mortality in the high-risk group of patients undergoing emergent laparotomy (EL). Methods: Using the 2011-2012 ACS-NSQIP database, we identified all patients who underwent EL using: 1) the ACS-NSQIP definition of "emergent", and 2) all CPT codes for laparotomy, excluding aortic aneurysm ruptures. Multivariable logistic regression analyses measured the correlation (c-statistic) between ESAS and: 1) 30-day mortality, and 2) 30-day morbidity in EL. As a sensitivity analysis, the correlation between ESAS and 30-day mortality was evaluated in CPT code subgroups. Results: A total of 26,410 EL patients were included. Thirty-day mortality and morbidity were 10.2% and 43.8%, respectively. ESAS correlated well with mortality (c-statistic 0.84), with scores of 1, 11, and 22 correlating with mortalities of 0.4%, 39.4% and 100%, respectively. ESAS correlated well with morbidity (c-statistic 0.74), with scores of 0, 7, and 15 correlating with complication rates of 13.1%, 57.5% and 93%, respectively, plateauing for scores >15. In sensitivity analyses, ESAS effectively predicted mortality in patients undergoing emergent splenic, gastroduodenal, intestinal, hepatobiliary, or incarcerated ventral hernia surgery [Table 1]. Conclusion: ESAS accurately predicts outcomes in all types of EL patients and may be a valuable bedside decision-making tool for patient and family counseling, as well as for adequate risk-adjustment in EL quality benchmarking efforts.
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