Performance of the Emergency Surgery Score for Predicting Outcomes after Non-Elective Open Aortic Aneurysm Repair

Abstract

Introduction: The Emergency Surgery Score (ESS) is a reliable tool to predict outcomes after emergency general surgery. The purpose of this study was to assess the performance of ESS for non-elective open aortic aneurysm repair (neOAR) Methods: The American College of Surgeons’ National Surgical Quality Improvement Program database was retrospectively analyzed for patients undergoing neOAR between 2015 and 2020. The performance of the ESS in predicting mortality and other outcomes was assessed using univariate and multivariate logistic regression with receiver operating characteristic analyses. Results: 838 patients underwent neOAR with a 30-day mortality of 23.4%. The ESS correlated with risk of death (C-statistic 0.753), discharge to facility (C-statistic 0.668), postoperative bleeding (C-statistic 0.687), and cardiopulmonary arrest (C-statistic 0.654). A cumulative frequency table of mortality was used to partition patients into quartiles of ESS < 5, ESS of 6, ESS of 7 or 8, and ESS > 9. A Cochran- Armitage test showed linear trend towards adverse outcomes like mortality (p < 0.001), prolonged hospital stay (p = 0.047), prolonged ICU stay (p < 0.001), return to OR (p < 0.001), renal failure (p < 0.001), reintubation (p = 0.009) and colitis (p < 0.001) among the quartiles with increasing ESS. Multivariate analysis including variables like proximal clamp site and hypotension on presentation showed that Quartile 4 (ESS>10) had 3-times higher mortality compared with reference quartile 1 (ESS<5) Conclusion: ESS performance accurately predicts mortality for neOAR procedures. It has the potential to be used for national benchmarking after urgent open aneurysm repair