Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
J Surg Res. 2021 May;261:152-158. doi: 10.1016/j.jss.2020.12.014. Epub 2021 Jan 8.
The Emergency Surgery Score (ESS) has been previously validated as a reliable tool to predict postoperative outcomes in emergency general surgery (EGS). The purpose of this study is to assess the differential performance of the ESS in specific EGS procedures.
The American College of Surgeons' National Surgical Quality Improvement Program database was retrospectively analyzed for patients undergoing EGS between 2007 and 2017. Patients who underwent the following EGS procedures were identified: laparoscopic appendectomy, laparoscopic cholecystectomy, surgery for small bowel obstruction (SBO), colectomy, and incarcerated ventral or inguinal hernia repair. The performance of the ESS in predicting mortality in each procedure was assessed using receiver operating characteristic analyses.
A total of 467,803 patients underwent EGS (mean age 50 ± 19.9 y, females 241,330 [51.6%]), of which 191,930 (41%) underwent laparoscopic appendectomy, 40,353 (8.6%) underwent laparoscopic cholecystectomy, and 35,152 (7.5%) patients underwent surgery for SBO. The ESS correlated extremely well with mortality for patients who underwent laparoscopic appendectomy (area under the curve (AUC) 0.91), laparoscopic cholecystectomy (AUC 0.91), lysis of adhesions for SBO (AUC 0.83), colectomy (AUC 0.83), and incarcerated hernia repair (AUC 0.85).
ESS performance accurately predicts mortality across a wide range of EGS procedures, and its use should be encouraged for preoperative patient counseling and for nationally benchmarking the quality of care of EGS.
紧急外科评分（ESS）此前已被验证为一种可靠的工具，可用于预测急诊普通外科（EGS）的术后结果。本研究的目的是评估 ESS 在特定 EGS 手术中的差异表现。
回顾性分析了 2007 年至 2017 年期间接受 EGS 的美国外科医师学院国家手术质量改进计划数据库中的患者。确定了接受以下 EGS 手术的患者：腹腔镜阑尾切除术、腹腔镜胆囊切除术、小肠梗阻（SBO）手术、结肠切除术和嵌顿性腹侧或腹股沟疝修补术。使用接收者操作特征分析评估 ESS 在预测每种手术死亡率方面的表现。
共有 467803 名患者接受了 EGS（平均年龄 50±19.9 岁，女性 241330[51.6%]），其中 191930（41%）接受了腹腔镜阑尾切除术，40353（8.6%）接受了腹腔镜胆囊切除术，35152（7.5%）患者接受了 SBO 手术。ESS 与接受腹腔镜阑尾切除术（曲线下面积（AUC）0.91）、腹腔镜胆囊切除术（AUC 0.91）、SBO 粘连松解术（AUC 0.83）、结肠切除术（AUC 0.83）和嵌顿疝修补术（AUC 0.85）的患者死亡率相关性极高。
ESS 表现准确预测了广泛的 EGS 手术的死亡率，应鼓励其用于术前患者咨询和国家基准 EGS 护理质量。
