Massachusetts Chapter of the American College of Surgeons

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The Emergency Surgery Score (ESS) Accurately Predicts the Risk of Postoperative Infection in Emergency General Surgery
Kelsey Han, BA, Jae Moo Lee, BA, Aditya Achanta, BA, Napaporn Kongkaewpaisan, MD, Manasnun Kongwibulwut, MD, Ahmed Eid, MD, MSc, Nikolaos Kokoroskos, MD, Suzanne van Wijck, BSc, Karien Meier, MSc, Ask Nordestgaard BSc, Gabriel Rodriguez, MD, Zhenyi Jia, MD, Jarone Lee, MD, MPH, David King, MD, Peter Fagenholz, MD, Noelle Saillant, MD, April Mendoza, MD, MPH, Martin Rosenthal, MD, George Velmahos, MD, PhD, Haytham M.A. Kaafarani, MD, MPH
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston Massachusetts.

Background: The Emergency Surgery Score (ESS) was recently validated as an accurate postoperative mortality risk calculator specific for Emergency General Surgery (EGS). ESS is calculated by adding integer points for 22 preoperative variables (demographics, co-morbidities, and preoperative laboratory values); increasing scores gradually predict higher mortality rates. We evaluated whether ESS can predict the occurrence of post-operative infectious complications in EGS patients.

Methods: Using the ACS-NSQIP database from 2007-2015, all EGS patients were identified by using the “emergent” variable and concomitant surgery CPT code for “digestive system”. Patients with missing ESS variables or those who died within 72 hours from surgery were excluded. A composite variable, postoperative infection, was created and defined as the occurrence of one or more of the following: superficial, deep incisional or organ/space surgical site infection, wound disruption, pneumonia, sepsis, septic shock, or urinary tract infection. ESS was calculated for all patients, and the correlation between ESS and postoperative infection was examined using c-statistics.

Results: Of 4,456,809 patients, 90,412 patients were included. The mean age of the population was 56 years, 51% were female, and 70% were white; 22% developed one or more post-operative infections, most commonly sepsis/septic shock (12.2%), surgical site infection (9%), and pneumonia (5.7%). ESS predicted infectious complications with 7%, 24%, and 49% of patients with an ESS of 1, 5, and 10 developing postoperative infections. The c-statistics for postoperative infection, postoperative sepsis/septic shock and pneumonia were 0.73, 0.75 and 0.80.

Conclusion: ESS accurately predicts the occurrence of postoperative infectious complications in EGS patients.

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USS Constitution
Paul Revere