紧急手术评分（ESS）能准确预测行急诊普外科手术的老年患者的结局。
The Emergency Surgery Score (ESS) accurately predicts outcomes in elderly patients undergoing emergency general surgery.
机构信息
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA; Center for Outcomes & Patient Safety in Surgery (COMPASS), Massachusetts General Hospital, Boston, MA, USA.
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
出版信息
Am J Surg. 2020 Oct;220(4):1052-1057. doi: 10.1016/j.amjsurg.2020.02.017. Epub 2020 Feb 17.
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.
背景
急诊手术评分（ESS）是一种经过验证的风险计算器，但其在老年急诊普通外科（EGS）患者中的表现尚不清楚。我们假设 ESS 能准确预测老年 EGS 患者的结局，包括 80 岁及以上和 90 岁及以上的患者。
方法
我们使用了 2007-2017 年国家外科质量改进计划（NSQIP）数据库，纳入了所有≥65 岁的 EGS 患者。使用曲线下面积（AUC）评估 ESS 与死亡率和发病率在 3 组患者（>65 岁、80 岁及以上和 90 岁及以上）中的相关性。
结果
共纳入 124335 例患者，其中 34215 例（28%）为 80 岁及以上，7239 例（6%）为 90 岁及以上。在≥65 岁的患者中，ESS 能准确预测死亡率（AUC 0.81）。对于 80 岁及以上和 90 岁及以上的患者，ESS 对死亡率的预测效果中等（AUC 分别为 0.77 和 0.69）。
结论
ESS 能准确预测老年 EGS 患者的死亡率和发病率，但对 90 岁及以上患者的发病率预测准确性降低。
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