The Emergency Surgery Score (ESS) accurately predicts outcomes in elderly patients undergoing emergency general surgery

Abstract

Background: The performance of the Emergency Surgery Score (ESS), a validated risk calculator, in the elderly emergency general surgery (EGS) patient remains unclear. We hypothesized that ESS accurately predicts outcomes in elderly EGS patients, including octogenarians and nonagenarians.

Methods: Using the 2007-2017 National Surgical Quality Improvement Program (NSQIP) database, we included all EGS patients ≥65 years old. The correlation between ESS, mortality and morbidity was assessed in the 3 patient cohorts (>65, octogenarians and nonagenarians), using the area under the curve (AUC).

Results: A total of 124,335 patients were included, of which 34,215 (28%) were octogenarians and 7239 (6%) were nonagenarians. In patients ≥65 years, ESS accurately predicted mortality (AUC 0.81). For octogenarians and nonagenarians, ESS predicted mortality moderately well (AUC 0.77 and 0.69, respectively.

Conclusion: ESS accurately predicts mortality and morbidity in the elderly EGS patient, but its accuracy in predicting morbidity decreases for nonagenarians.

Keywords: Benchmarking; Emergency surgery; General surgery; Mortality; Outcomes.