TY - JOUR
T1 - Emergency Surgery Score Accurately Predicts the Risk of Post-Operative Infection in Emergency General Surgery
AU - Han, Kelsey
AU - Lee, Jae Moo
AU - Achanta, Aditya
AU - Kongkaewpaisan, Napaporn
AU - Kongwibulwut, Manasnun
AU - Eid, Ahmed I
AU - Kokoroskos, Nikolaos
AU - van Wijck, Suzanne
AU - Meier, Karien
AU - Nordestgaard, Ask
AU - Rodriguez, Gabriel
AU - Jia, Zhenyi
AU - Lee, Jarone
AU - King, David
AU - Fagenholz, Peter
AU - Saillant, Noelle
AU - Mendoza, April
AU - Rosenthal, Martin
AU - Velmahos, George
AU - Kaafarani, Haytham M A
PY - 2019/1
Y1 - 2019/1
N2 - BACKGROUND: The Emergency Surgery Score (ESS) was validated recently as an accurate and user-friendly post-operative mortality risk calculator specific for Emergency General Surgery (EGS). ESS is calculated by adding one to three integer points for each of 22 pre-operative variables (demographics, co-morbidities, and pre-operative laboratory values); increasing scores accurately and gradually predict higher mortality rates. We sought to evaluate whether ESS can predict the occurrence of post-operative infectious complications in EGS patients.PATIENTS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2007-2015, all EGS patients were identified by using the "emergent" ACS-NSQIP variable and a concomitant surgery Current Procedural Terminology code for "digestive system." Patients with any missing ESS variables or those who died within 72 hours from the surgical procedure were excluded. A composite variable, post-operative infection, was created and defined as the post-operative occurrence of one or more of the following: superficial, deep incisional or organ/space surgical site infection, surgical site disruption, pneumonia, sepsis, septic shock, or urinary tract infection. ESS was calculated for all included patients, and the correlation between ESS and post-operative infection was examined using c-statistics.RESULTS: Of a total 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%). The ESS gradually and consistently predicted infectious complications; post-operative infections developed in 7%, 24%, and 49% of patients with an ESS of 1, 5, and 10, respectively. The c-statistics for overall post-operative infection, post-operative sepsis/septic shock, and pneumonia were 0.73, 0.75, and 0.80, respectively.CONCLUSION: The ESS accurately predicts the occurrence of post-operative infectious complications in EGS patients and could be used for pre-operative clinical decision-making as well as quality benchmarking of infection rates in EGS.
AB - BACKGROUND: The Emergency Surgery Score (ESS) was validated recently as an accurate and user-friendly post-operative mortality risk calculator specific for Emergency General Surgery (EGS). ESS is calculated by adding one to three integer points for each of 22 pre-operative variables (demographics, co-morbidities, and pre-operative laboratory values); increasing scores accurately and gradually predict higher mortality rates. We sought to evaluate whether ESS can predict the occurrence of post-operative infectious complications in EGS patients.PATIENTS AND METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2007-2015, all EGS patients were identified by using the "emergent" ACS-NSQIP variable and a concomitant surgery Current Procedural Terminology code for "digestive system." Patients with any missing ESS variables or those who died within 72 hours from the surgical procedure were excluded. A composite variable, post-operative infection, was created and defined as the post-operative occurrence of one or more of the following: superficial, deep incisional or organ/space surgical site infection, surgical site disruption, pneumonia, sepsis, septic shock, or urinary tract infection. ESS was calculated for all included patients, and the correlation between ESS and post-operative infection was examined using c-statistics.RESULTS: Of a total 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%). The ESS gradually and consistently predicted infectious complications; post-operative infections developed in 7%, 24%, and 49% of patients with an ESS of 1, 5, and 10, respectively. The c-statistics for overall post-operative infection, post-operative sepsis/septic shock, and pneumonia were 0.73, 0.75, and 0.80, respectively.CONCLUSION: The ESS accurately predicts the occurrence of post-operative infectious complications in EGS patients and could be used for pre-operative clinical decision-making as well as quality benchmarking of infection rates in EGS.
KW - Aged
KW - Aged, 80 and over
KW - Communicable Diseases/epidemiology
KW - Decision Support Techniques
KW - Emergency Medical Services/methods
KW - Female
KW - General Surgery/methods
KW - Humans
KW - Male
KW - Middle Aged
KW - Postoperative Complications/epidemiology
KW - Risk Assessment
KW - Surgical Procedures, Operative/adverse effects
KW - surgical site infection
KW - emergency general surgery
KW - post-operative infection
KW - post-operative complication
KW - emergency surgery score
UR - http://www.scopus.com/inward/record.url?scp=85059389119&partnerID=8YFLogxK
U2 - 10.1089/sur.2018.101
DO - 10.1089/sur.2018.101
M3 - Journal article
C2 - 30272533
SN - 1096-2964
VL - 20
SP - 4
EP - 9
JO - Surgical Infections
JF - Surgical Infections
IS - 1
ER -