Ghali Mohamed Said, Hasan Samer A, Al-Qudimat Ahmad R, Alabidi Mohammed, Moustafa Omar S, Al-Zoubi Raed M
Department of Acute Care Surgery, Hamad Medical Corporation, Doha, Qatar.
Department of General Surgery, Ain Shams University, Cairo, Egypt.
Eur J Trauma Emerg Surg. 2025 May 22;51(1):216. doi: 10.1007/s00068-025-02888-6.
The Emergency Surgery Score (ESS) has demonstrated strong predictive value for morbidity, mortality, and long-term survival outcomes. However, its applicability and validity in the Middle East and North Africa (MENA) region remain understudied. This research seeks to validate ESS's ability to predict postoperative outcomes, including 30-day mortality, complications, and ICU admissions, among patients undergoing emergency laparotomies (EL).
This retrospective study analyzed 230 EL cases from 2017 to 2021. ESS scores were calculated for each patient, and its predictive accuracy was compared with the American Society of Anesthesiologists (ASA) classification using c-statistic methodology. We also compared postoperative outcomes between MENA and non-MENA cohorts to assess potential regional variations in ESS performance.
Out of 230 patients, 118 were from MENA and 112 from non-MENA regions. Sepsis was the most common diagnosis (69.6%). ICU admission was recorded in 63.4% of cases, and the 30-day mortality rate was 13.91%. ESS scores did not differ significantly between MENA and non-MENA patients (median: 7.5 vs. 7; P = 0.45). ESS outperformed ASA in predicting postoperative outcomes: complications (c-statistic: 0.79 vs. 0.73), ICU admissions (0.81 vs. 0.76), and mortality (0.86 vs. 0.78). Optimal ESS cutoffs for complications, ICU need, and mortality were 6, 8, and 10, respectively. ESS performed similarly across both MENA and non-MENA populations in predicting mortality, complications, and ICU admissions.
The ESS is a superior tool compared to ASA for predicting postoperative outcomes in emergency surgical patients, and it is applicable to diverse populations, including those from the MENA region. ESS enhances preoperative risk stratification, informs counseling decisions, and supports quality benchmarking across different healthcare settings. Future studies should address potential biases, including selection and information bias, and further explore ESS's role in different cultural contexts.
急诊手术评分（ESS）已被证明对发病率、死亡率和长期生存结果具有很强的预测价值。然而，其在中东和北非（MENA）地区的适用性和有效性仍未得到充分研究。本研究旨在验证ESS预测急诊剖腹手术（EL）患者术后结果的能力，包括30天死亡率、并发症和重症监护病房（ICU）入院情况。
这项回顾性研究分析了2017年至2021年的230例EL病例。计算了每位患者的ESS评分，并使用c统计方法将其预测准确性与美国麻醉医师协会（ASA）分类进行比较。我们还比较了MENA和非MENA队列的术后结果，以评估ESS性能的潜在区域差异。
230例患者中，118例来自MENA地区，112例来自非MENA地区。脓毒症是最常见的诊断（69.6%）。63.4%的病例记录了ICU入院情况，30天死亡率为13.91%。MENA和非MENA患者的ESS评分无显著差异（中位数：7.5对7；P = 0.45）。在预测术后结果方面，ESS优于ASA：并发症（c统计量：0.79对0.73）、ICU入院（0.81对0.76）和死亡率（0.86对0.78）。并发症、ICU需求和死亡率的最佳ESS临界值分别为6、8和10。在预测死亡率、并发症和ICU入院方面，ESS在MENA和非MENA人群中的表现相似。
与ASA相比，ESS是预测急诊手术患者术后结果的更优工具，适用于包括MENA地区人群在内的不同人群。ESS增强了术前风险分层，为咨询决策提供信息，并支持不同医疗环境下的质量基准。未来的研究应解决潜在的偏倚，包括选择偏倚和信息偏倚，并进一步探索ESS在不同文化背景中的作用。
