The emergency surgery score (ESS) and outcomes in elderly patients undergoing emergency laparotomy: A post-hoc analysis of an EAST multicenter study

Majed El Hechi, Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
Napaporn Kongkaewpaisan, Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA; Division of Acute Care and Ambulatory Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Mohamad El Moheb, Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
Brittany Aicher, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
Jose Diaz, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
Lindsay OʼMeara, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
Cassandra Decker, UCHealth Memorial Hospital Central Trauma Center, Colorado Springs, CO, USA.
Jennifer Rodriquez, UCHealth Memorial Hospital Central Trauma Center, Colorado Springs, CO, USA.
Thomas Schroeppel, UCHealth Memorial Hospital Central Trauma Center, Colorado Springs, CO, USA.
Rishi Rattan, The DeWitt Daughtry Family Department of Surgery Ryder Trauma Center/ Jackson Memorial Hospital, Miami, FL, USA.
Georgia Vasileiou, The DeWitt Daughtry Family Department of Surgery Ryder Trauma Center/ Jackson Memorial Hospital, Miami, FL, USA.
D Dante Yeh, The DeWitt Daughtry Family Department of Surgery Ryder Trauma Center/ Jackson Memorial Hospital, Miami, FL, USA.
Ursula Simonosk, Loma Linda University Medical Center, Loma Linda, CA, USA.
David Turay, Loma Linda University Medical Center, Loma Linda, CA, USA.
Daniel Cullinane, Marshfield Clinic, Marshfield, WI, USA.
Cory Emmert, Marshfield Clinic, Marshfield, WI, USA.
Marta McCrum, University of Utah, Salt Lake City, UT, USA.
Natalie Wall, University of Utah, Salt Lake City, UT, USA.
Jeremy Badach, Cooper University Hospital, Camden, NJ, USA.
Anna Goldenberg-Sanda, Cooper University Hospital, Camden, NJ, USA.
Heather Carmichael, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Catherine Velopulos, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Rachel Choron, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Joseph Sakran, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Khaldoun Bekdache, Eastern Maine Medical Center, Bangor, ME, USA.
George Black, University of Texas Southwestern Medical Center and Parkland Hospital, Dallas, TX, USA.
Thomas Shoultz, University of Texas Southwestern Medical Center and Parkland Hospital, Dallas, TX, USA.
Zachary Chadnick, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA.
Vasiliy Sim, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA.
Firas Madbak, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
Daniel Steadman, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
Maraya Camazine, Mayo Clinic, Rochester, MN, USA.

Abstract

INTRODUCTION: We sought to evaluate whether the Emergency Surgery Score (ESS) can accurately predict outcomes in elderly patients undergoing emergent laparotomy (EL). METHODS: This is a post-hoc analysis of an EAST multicenter study. Between April 2018 and June 2019, all adult patients undergoing EL in 19 participating hospitals were prospectively enrolled, and ESS was calculated for each patient. Using the c-statistic, the correlation between ESS and mortality, morbidity, and need for ICU admission was assessed in three patient age cohorts (65-74, 75-84, ≥85 years old). RESULTS: 715 patients were included, of which 52% were 65-74, 34% were 75-84, and 14% were ≥85 years old; 51% were female, and 77% were white. ESS strongly correlated with postoperative mortality (c-statistic:0.81). Mortality gradually increased from 0% to 20%-60% at ESS of 2, 10 and 16 points, respectively. ESS predicted mortality, morbidity, and need for ICU best in patients 65-74 years old (c-statistic:0.81, 0.75, 0.83 respectively), but its performance significantly decreased in patients ≥85 years (c-statistic:0.72, 0.64, 0.67 respectively). CONCLUSION: ESS is an accurate predictor of outcome in the elderly EL patient 65-85 years old, but its performance decreases for patients ≥85. Consideration should be given to modify ESS to better predict outcomes in the very elderly patient population.