The Emergency Surgery Score (ESS) Accurately Predicts the Occurrence of Postoperative Complications in Emergency Surgery Patients.

Background: The Emergency Surgery Score (ESS) was recently validated as a scoring system to predict mortality in emergency surgery (ES) patients. We sought to examine the ability of ESS to predict the occurrence of 30-day postoperative complications in ES. Methods: The 2011-2012 American College of Surgeons National Surgical Quality. Improvement Program (ACS-NSQIP) database was screened for all surgical operations classified as "emergent". Thirty-day postoperative complications were defined as per ACS-NSQIP (e.g. surgical site infection, respiratory failure, acute renal failure). Each patient-related ESS was calculated, and the correlation between ESS and the probability of occurrence of 30-day postoperative complications was assessed by calculating the c-statistic. Univariate and multivariable models were also created to identify which ESS components independently predict complications. Results: Of 37,999 cases that captured all ESS variables, 14,446 (38%) resulted in at least one 30-day complication. The observed probability of a 30-day complication gradually increased from 7% to 53% to 91% at scores of 0, 7, and 15, respectively, with a c-statistic of 0.78. For ESS>15, the complication rate plateaued at a mean of 92%. On multivariable analyses, each of the 22 ESS components independently predicted the occurrence of postoperative complications. Conclusions: ESS reliably predicts postoperative complications in ES patients. Such a score could prove useful for: 1) perioperative patient and family counseling and 2) benchmarking the quality of ES care. Level of Evidence: Level III Study Type: Prognostic (C) 2017 Lippincott Williams & Wilkins, Inc.

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