Division of Trauma, Emergency Surgery & Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
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.
Am J Surg. 2021 May;221(5):1069-1075. doi: 10.1016/j.amjsurg.2020.08.039. Epub 2020 Sep 4.
We sought to evaluate whether the Emergency Surgery Score (ESS) can accurately predict outcomes in elderly patients undergoing emergent laparotomy (EL).
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).
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).
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.
我们旨在评估紧急手术评分（ESS）是否能准确预测行急诊剖腹术（EL）的老年患者的结局。
这是 EAST 多中心研究的事后分析。2018 年 4 月至 2019 年 6 月，所有在 19 家参与医院行 EL 的成年患者均前瞻性纳入研究，并为每位患者计算 ESS。使用 C 统计量评估 ESS 与死亡率、发病率和 ICU 入住需求之间的相关性，分为三组患者年龄（65-74 岁、75-84 岁、≥85 岁）。
共纳入 715 例患者，其中 52%为 65-74 岁，34%为 75-84 岁，14%为≥85 岁；51%为女性，77%为白人。ESS 与术后死亡率密切相关（C 统计量：0.81）。死亡率逐渐从 0%增加到 20%-60%，ESS 分别为 2、10 和 16 分。ESS 在 65-74 岁患者中预测死亡率、发病率和 ICU 入住需求最佳（C 统计量：0.81、0.75、0.83），但在≥85 岁患者中性能显著下降（C 统计量：0.72、0.64、0.67）。
ESS 是 65-85 岁老年 EL 患者结局的准确预测指标，但在≥85 岁患者中性能下降。应考虑修改 ESS，以更好地预测非常老年患者人群的结局。
