Division of Vascular Surgery, University of Missouri, Columbia, MO.
Division of Vascular Surgery, University of Missouri, Columbia, MO.
Surgery. 2023 Mar;173(3):830-836. doi: 10.1016/j.surg.2022.07.038. Epub 2022 Nov 2.
The Emergency Surgery Score has been previously validated as a reliable; tool to predict postoperative outcomes in emergency general surgery. The purpose of this study was to assess the performance of the Emergency Surgery Score for infrainguinal open revascularization procedures in the nonelective setting.
The American College of Surgeons' National Surgical Quality Improvement Program database was retrospectively analyzed for patients undergoing infrainguinal open revascularization procedures in the nonelective setting between 2015 and 2019. The performance of the Emergency Surgery Score in predicting mortality in each procedure was assessed using receiver operating characteristic analyses.
A total of 5,027 patients underwent infrainguinal open revascularization procedures in the nonelective setting with median age 68 (±11.66 standard deviation), with 1,666 females (33.1%). The 30-day mortality rate was 2.7%. The Emergency Surgery Score correlated with 30-day mortality (area under the curve was 0.738). The Emergency Surgery Score also predicted risk of death/discharge to hospice (area under the curve 0.756), discharge to rehab (area under the curve 0.643), renal failure (area under the curve 0.741), postintervention ventilation requirement (0.684), stroke (0.717), cardiopulmonary arrest (0.657), and septic shock (0.697). A cumulative frequency table of mortality with Emergency Surgery Score was used to partition patients into quartiles of Emergency Surgery Score ≤5, Emergency Surgery Score of 6, Emergency Surgery Score of 7 or 8, and Emergency Surgery Score ≥9. A Cochran-Armitage test showed linear trend toward increased 30-day mortality among the quartiles with increasing Emergency Surgery Score (P < .001), with quartile 4 (Emergency Surgery Score ≥10) having 13 times odds of increased 30-day mortality compared to reference quartile 1 (Emergency Surgery Score ≤4).
Emergency Surgery Score performance accurately predicts mortality for infrainguinal open revascularization procedures in the nonelective setting procedures. It may be useful for preoperative risk stratification and for national benchmarking after nonelective open lower extremity procedures.
急诊手术评分已被验证为一种可靠的工具，可用于预测急诊普外科手术后的结局。本研究的目的是评估急诊手术评分在非择期情况下用于股腘动脉旁路开放手术的表现。
回顾性分析了 2015 年至 2019 年期间在非择期情况下接受股腘动脉旁路开放手术的美国外科医师学院国家外科质量改进计划数据库中的患者。使用接受者操作特征分析评估急诊手术评分在预测每种手术死亡率中的表现。
共有 5027 例患者在非择期情况下接受股腘动脉旁路开放手术，中位年龄为 68（±11.66 标准差）岁，女性 1666 例（33.1%）。30 天死亡率为 2.7%。急诊手术评分与 30 天死亡率相关（曲线下面积为 0.738）。急诊手术评分还预测了死亡/临终关怀出院（曲线下面积 0.756）、康复出院（曲线下面积 0.643）、肾衰竭（曲线下面积 0.741）、术后通气需求（0.684）、中风（0.717）、心肺骤停（0.657）和感染性休克（0.697）的风险。使用急诊手术评分的死亡率累积频率表将患者分为四组：急诊手术评分≤5 分、急诊手术评分 6 分、急诊手术评分 7 分或 8 分和急诊手术评分≥9 分。Cochran-Armitage 检验显示，随着急诊手术评分的增加，30 天死亡率呈线性趋势（P<.001），第 4 四分位数（急诊手术评分≥10）的 30 天死亡率比第 1 四分位数（急诊手术评分≤4）增加了 13 倍。
急诊手术评分在非择期情况下股腘动脉旁路开放手术中的表现准确预测了死亡率。它可能有助于术前风险分层和非择期下肢开放手术后的全国基准测试。
