Emergency Surgery Score Research Articles

The validity of emergency surgery score in predicting mortality and complications in general surgical emergencies.

The validity of emergency surgery score in predicting mortality and complications in general surgical emergencies.

Validation of the emergency surgery score (ESS) in a UK patient population and comparison with NELA scoring: a retrospective multicentre cohort study.

Accurate risk scoring in emergency general surgery (EGS) is vital for consent and resource allocation. The emergency surgery score (ESS) has been validated as a reliable preoperative predictor of postoperative outcomes in EGS but has been studied only in the US population. Our primary aim was to perform an external validation study of the ESS in a UK population. Our secondary aim was to compare the accuracy of ESS and National Emergency Laparotomy Audit (NELA) scores. We conducted an observational cohort study of adult patients undergoing emergency laparotomy over three years in two UK centres. ESS was calculated retrospectively. NELA scores and all other variables were obtained from the prospectively collected Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database. The primary and secondary outcomes were 30-day mortality and postoperative intensive care unit (ICU) admission, respectively. A total of 609 patients were included. Median age was 65 years, 52.7% were female, the overall mortality was 9.9% and 23.8% were admitted to ICU. Both ESS and NELA were equally accurate in predicting 30-day mortality (c-statistic=0.78 (95% confidence interval (CI), 0.71-0.85) for ESS and c-statistic=0.83 (95% CI, 0.77-0.88) for NELA, p=0.196) and predicting postoperative ICU admission (c-statistic=0.76 (95% CI, 0.71-0.81) for ESS and 0.80 (95% CI, 0.76-0.85) for NELA, p=0.092). In the UK population, ESS and NELA both predict 30-day mortality and ICU admission with no statistically significant difference but with higher c-statistics for NELA score. Both scores have certain advantages, with ESS being validated for a wider range of outcomes.

Evaluating the Emergency Surgery Score (ESS) in Predicting Postoperative Outcomes Following Emergency Laparotomy: Insights From an Indian Tertiary Center.

To determine the predictive value of Emergency Surgery Score (ESS) with regard to mortality and morbidity rates of patients undergoing emergency laparotomy. The ESSranging from 0 to 29 is an extensive risk calculator based on 22 variables including important parameters like demographics, preoperative treatment, comorbidities, and laboratory values. Twenty patients who underwent emergency laparotomy were preoperatively assessed and ESS was calculated for each. After establishment of diagnosis and resuscitation, the patient was taken up for emergency laparotomy. Postoperatively, patients were monitored clinically as well as with laboratory and radiological investigations as per case needed till discharge and further followed up physically in OPD/ward or interviewed telephonically for 30 days on a weekly basis. Incidence of mortality and morbidity in terms of postoperative complications, ICU admission, reoperation and readmission among the cases occurring within 30 days of procedure were recorded. ESS correlated well with the outcome in the current study, 10 out of 14 patients with score less than 8 were discharged without any complications. Mean ESS was higher among non-survivors. Ability of ESS to predict postoperative mortality, morbidity and ICU stay was proven statistically with c-statistics of 0.853, 0.84, 0.879 respectively. ESS was found to be a good predictor for the development of postoperative lower respiratory tract infection (LRTI) (c-statistic=0.828), sepsis (c-statistic=0.867), disseminated intravascular coagulation (DIC) (c-statistic=0.805), acute kidney injury (AKI) (c-statistic=0.804). ESS showed poor correlation with reoperation and readmission rates. The current study underscores the critical importance of employing risk stratification throughESSfor patients undergoing emergency laparotomy. By employing ESS, healthcare professionals can accurately anticipate resuscitation requirements and stabilize patients preoperatively. This proactive approach enables the identification and optimization of patients unsuitable for immediate surgery, facilitating informed decisions on targeted treatment, surgical intervention, and postoperative care pathways.

Machine learning based peri-surgical risk calculator for abdominal related emergency general surgery: a multicenter retrospective study.

Currently, there is a lack of ideal risk prediction tools in the field of emergency general surgery (EGS). The American Association for the Surgery of Trauma recommends developing risk assessment tools specifically for EGS-related diseases. In this study, we sought to utilize machine learning (ML) algorithms to explore and develop a web-based calculator for predicting five perioperative risk events of eight common operations in EGS. This study focused on patients with EGS and utilized electronic medical record systems to obtain data retrospectively from five centers in China. Five ML algorithms, including Random Forest (RF), Support Vector Machine, Naive Bayes, XGBoost, and Logistic Regression, were employed to construct predictive models for postoperative mortality, pneumonia, surgical site infection, thrombosis, and mechanical ventilation >48 h. The optimal models for each outcome event were determined based on metrics, including the value of the Area Under the Curve, F1 score, and sensitivity. A comparative analysis was conducted between the optimal models and Emergency Surgery Score (ESS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and American Society of Anesthesiologists (ASA) classification. A web-based calculator was developed to determine corresponding risk probabilities. Based on 10,993 patients with EGS, we determined the optimal RF model. The RF model also exhibited strong predictive performance compared with the ESS, APACHE II score, and ASA classification. Using this optimal model, we developed an online calculator with a questionnaire-guided interactive interface, catering to both the preoperative and postoperative application scenarios. We successfully developed an ML-based calculator for predicting the risk of postoperative adverse events in patients with EGS. This calculator accurately predicted the occurrence risk of five outcome events, providing quantified risk probabilities for clinical diagnosis and treatment.

Early postoperative complications of elective versus emergency stoma creation: a tertiary academic center experience.

Stoma creation is standard in general surgery, yet complication rates remain high. This study investigated the incidence and risk factors for early postoperative stoma complications in elective vs emergency surgery. All patients who underwent stoma creation between June 2015 and November 2020 were retrospectively reviewed and analyzed. Patients were divided into 2 groups based on the surgery type: elective vs emergency. A total of 375 patients were included in this study. Two hundred fifty-three patients (67.5%) underwent elective stoma creation, while 122 (32.5%) underwent stoma creation during an emergency surgery. In the emergency group, white blood cell, blood urea nitrogen, and creatinine levels were statistically significantly higher (P = .001, .001, and .002, respectively). Albumin levels were statistically significantly lower in the emergency group (P = .001). The mean Emergency Surgery Score was 5.17 ± 2.73 in the emergency group compared to 4.4 ± 2.44 in the elective group (P = .006). Colorectal cancer was the most common cause of stoma creation in both groups. In terms of stoma creation, colostomy was statistically significantly more common in the emergency group (59%, P = .001), compared to ileostomy in the elective group (58.9%, P = .001). Complications were observed in 135 of all patients (36%). Necrosis was statistically significantly more common in emergency cases (9.9%, P < .001). Surgeons should strive to optimize the patient's condition prior to the operation and, if possible, perform stoma marking or involve a stoma nurse in the operating room to select the most suitable site. In high-risk patients, where complications are more likely, the use of a stoma should be minimized and definitive management should always be pursued if feasible.

Current status of research on emergency surgery score in trauma patients: a bibliometric analysis.

The use of a relevant emergency score can provide an accurate assessment of the patient's condition and prognosis. However, the status of related studies remains unclear. The current study analyzed the research status of emergency surgery score (ESS) of trauma patients by using bibliometric methods. The Science Citation Index Expanded (SCI-E) database in the Web of Science Core Collection (WOSCC) was searched using keywords "trauma" and "emergency surgery score". All records from the search results and cited references were exported to Excel, duplicate literature records were removed, information for the same author and organization in different signature forms were merged. The resulting literatures were analyzed by year of publication, citation, discipline, countries and research institutions, journals, authors, and use of keywords. The cooperation among countries, institutions, and authors was also examined. A total of 2,175 document were retrieved. The number of published literature and the number of citations per year increased annually. The number of published documents (n=1,029) and research cooperation (centrality score, 0.44) in the United States were significantly ahead of those in other countries. The ten research institutions with the largest number of published documents were all from the United States, with much cooperation between research institutions and authors. There were many publications from China (n=108), but with few cooperations (centrality score, 0.22). The journals with the largest number of published articles were professional in the fields of trauma, emergency, and critical care. Keyword analysis showed that infection and shock were important issues besides surgery in the research related to ESS of trauma patients. Research related to ESS of trauma patients has been mainly conducted in the United States, and Chinese researchers should increase their level of cooperation.

Effect of timing of enteral nutrition initiation on poor prognosis in patients after cardiopulmonary bypass: A prospective observational study

ObjectivesCurrent guidelines recommend that enteral nutrition (EN) be implemented as early as possible in patients after cardiopulmonary bypass (CPB), but the optimal time to initiate EN remains controversial. Therefore, the aim of this study was to investigate the effect of timing of EN initiation on poor prognosis in patients after CPB. MethodsThis was a prospective observational study with patients who underwent CPB in a tertiary hospital from September 1, 2021, to January 31, 2022. The patients were divided into three groups according to the timing of EN initiation: <24 h, 24 to 48 h, and >48 h. Unconditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals to identify independent risk factors for poor prognosis. ResultsThe study included 579 patients, of whom 255 patients had EN initiated at <24 h (44%), 226 at 24 to 48 h (39%), and at >48 h (17%). With EN <24 h as a reference, multivariate logistic analysis showed that EN 24 to 48 h (OR, 1.854, P = 0.008) and EN >48 h (OR, 7.486, P <0.001) were independent risk factors for poor prognosis after CPB. Age (OR, 1.032, P = 0.001), emergency surgery (OR, 10.051; P <0.001), surgical time (OR, 1.006; P <0.001), and sequential organ failure assessment score (OR, 1.269; P = 0.001) also increased the risk for poor prognosis after CPB. ConclusionsCompared with early EN <24 h, EN 24 to 48 h and EN >48 h increased the risk for poor prognosis in patients after CPB.

Comparison of different scoring systems in predicting mortality and postoperative complications in acute care surgery patients at a Saudi Academic Centre.

Emergency surgery carries an increased risk of death and complications. Scoring systems can help identify patients at higher risk of mortality and complications. Scoring systems can also help benchmark acute care services. This study aims to compare different scoring systems in predicting outcomes among acute care surgery patients. Our study is a retrospective cohort study that included all adult emergency surgery admissions between 2017 and 2019. Data were obtained from patients' electronic health records. Same admission mortality and postoperative complications were collected. Data were recorded to calculate the American Society of Anesthesiologists Physical Status classification system (ASA-PS), Shock Index Score (SI), Age Shock Index Score (AgeSI), and the Emergency Surgery Score (ESS). The probability of death and complications was correlated with each scoring system and was assessed by calculating the c-statistic. During the study period, 1606 patients fulfilled inclusion criteria. The mortality rate was 2.2%, complication rate was 18.7%. ESS predicted mortality with a c-statistic of 0.87 better than ASA-PS, AgeSI, and SI with a calculated c-statistic of 0.81, 0.74, and 0.57, respectively. ESS also predicted the occurrence of complications with a c-statistic of 0.83 better than ASA-PS, AgeSI, and SI with a calculated c-statistic of 0.72, 0.71, and 0.63, respectively. ESS demonstrated a better prognostic accuracy for hospital mortality and postoperative complications than other prognostic scoring systems. Our findings suggest that a scoring system designed for the acute care surgical population may provide enhanced prognostic performance over other surgical prognostic scoring systems.

Performance of the Emergency Surgery Score in Nonelective Lower-Extremity Endovascular Procedures

IntroductionMultiple studies have validated the Emergency Surgery Score (ESS) as a tool which reliably predicts outcomes after emergency general surgery. The purpose of this study was to assess the performance of the ESS for lower-extremity endovascular procedures in nonelective setting (neLEE). MethodsThe American College of Surgeons’ National Surgical Quality Improvement Program database was retrospectively analyzed for patients undergoing neLEE between 2015 and 2019. The performance of the ESS in predicting mortality in each procedure was assessed using receiver operating characteristic analyses. ResultsFour thousand five hundred and eighty three patients underwent neLEE with median age 68 (±12.3 SD), with 1802 females (39.3%). The ESS correlated with 30-day mortality (area under the curve [AUC] was 0.729), discharge to rehab (AUC 0.638), renal failure (AUC 0.667), postintervention ventilation requirement (AUC 0.680), and stroke (AUC 0.656). The predictive ability of the ESS decreased with increasing age, with the ESS performing best for patients between 60 and 69 y in age (AUC 0.735) and worst for patients above 80 y (AUC 0.650). A Cochran–Armitage test showed linear trend towards increased 30-day mortality among the quartiles with increasing ESS (P < 0.001), with patients with ESS ≥10 having 10 times odds of increased 30-day mortality compared to reference quartile of patients with ESS ≤4 on multivariate analysis. ConclusionsThe ESS score is associated with 30-day mortality and other complications after neLEE procedures. It can potentially be used as a predictive tool for preoperative risk stratification and can also be used for equitably evaluating standards and outcomes after lower extremity endovascular procedures.

Charlson Comorbidity Index as a Predictor of Difficult Cholecystectomy in Patients With Acute Cholecystitis.

Background The Charlson Comorbidity Index (CCI) has been validated as a predictor of overall survival and post-surgical mortality. CCI is adopted by Tokyo Guidelines as one of the main criteria in the management of acute cholecystitis. Our study evaluates the role of CCI in predicting difficult cholecystectomy. Methods All patients who underwent cholecystectomy for acute cholecystitis between January 2017 and September 2019 were included. CCI, Emergency Surgery Score (ESS), and American Society of Anesthesiologists (ASA) scorewere calculated and analyzed to assess their predictive value for difficult cholecystectomy. Results A total of 96 patients were included and allocated to difficult and non-difficult cholecystectomy groups. CCI was found to be a significant predictor of difficult cholecystectomy (OR 1.59; 59% CI, 1.04. 2.42; p= 0.031). Similarly, ESS was found to be a predictor tool of difficult cholecystectomy (OR 1.42; 59% CI, 1.05. 1.93; p= 0.024). There was no significant difference in adverse outcomes between the two groups. Conclusion CCI was able to predict a difficult cholecystectomy in our study population. However further studies are required to evaluate if it can be used as a predictor of adverse outcomes in the context of acute cholecystitis.

Anaesthesia related mortality data at a Tertiary Pediatric Hospital in Western Australia.

Anaesthesia related mortality in paediatrics is rare. There are limited data describing paediatric anaesthesia related mortality. This study determined the anaesthesia related mortality at a Tertiary Paediatric Hospital in Western Australia. A retrospective cohort study of children under-18 years of age, that died within 30-days of undergoing anaesthesia at Princess Margaret Hospital (PMH), between 01 January 2001 and 31 March 2015. A senior panel of clinicians reviewed each death to determine whether the death was (i) due wholly to the provision of anaesthesia (ii) due partly to the provision of anaesthesia or (iii) if death was related to the underlying pathology of the patient and anaesthesia was not contributory. Anaesthesia related mortality, 24-hand 30-day mortality as well as predictors of mortality were determined. A total of 154,538 anaesthetic events were recorded. There were 198 deaths within 30-days of anaesthesia. Anaesthesia attributable mortality was 0.19/10,000 with all anaesthesia deaths occuring in patients undergoing cardiothoracic surgery. The 24-h and 30-day all-cause mortality rate was 3.43/10,000 (95% CI 2.57-4.49) and 9.38/10,000 (95% CI 7.92-11.04), respectively. Overall mortality was 12.34/10,000 (95% CI 11.09-14.73) Age less than 1-year, cardiac surgery, emergency surgery and higher ASA score were all significant predictors of mortality. Paediatric anaesthesia related mortality as reflected in this retrospective cohort study is uncommon. Significant risk factors were determined as predictors of mortality.

Performance of the Emergency Surgery Score (ESS) for nonelective infrainguinal open revascularization procedures (NEIOR)

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.

Predicting mortality and morbidity in emergency general surgery patients in a Jordanian Tertiary Medical Center: a retrospective validation study of the Emergency Surgery Score (ESS)

ObjectiveThe Emergency Surgery Score (ESS) is a predictive tool used to assess morbidity and mortality rates in patients undergoing emergent surgery. This study explores the ESS’s predictive ability and reliability...

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

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

The Emergency Surgery Score as a Predictor for Blood Transfusion: NSQIP 2018 Data

The Emergency Surgery Score as a Predictor for Blood Transfusion: NSQIP 2018 Data

Performance Of The Emergency Surgery Score (ESS) For Non-elective Aortoiliac Endovascular Reconstructions

The Emergency Surgery Score (ESS) has been previously validated as a reliable tool to predict postoperative outcomes in emergency general surgeries and some vascular surgeries. The objective of this study was to assess the performance of the ESS for endovascular aortoiliac revascularization procedures in the nonelective setting (neAERs).

SP4.1.3 Validation of the Emergency Surgery Score (ESS) in the UK patient population and comparison with NELA scoring: a retrospective multi-centre cohort study

Abstract Aims Accurate risk scoring in emergency general surgery (EGS) is vital for consent, resource allocation and benchmarking quality of care. The emergency surgery score (ESS) is a reliable predictor of post-operative outcomes in EGS, but has only been studied in the US population. Our primary aim was to perform an external validation study of the ESS in a UK population. Our secondary aim was to compare the accuracy of ESS and NELA scores. Methods We conducted an observational cohort study of adult patients undergoing emergency laparotomy over three years in two UK centres. ESS was calculated retrospectively. NELA score and all other variables were obtained from the prospectively held Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) database. Primary outcome was 30-day mortality. Secondary outcome was need for post-operative ICU admission. Results 609 patients were included. Both ESS and NELA were good predictors of 30-day mortality (c-statistic=0.78 [95% CI: 0.71–0.85] for ESS and c-statistic=0.83 [95% CI: 0.77–0.88] for NELA). Similarly, both scores were good predictors of need for post-operative ICU admission (c-statistic=0.76 [95% CI: 0.71–0.81] for ESS and 0.80 [95% CI: 0.76–0.85] for NELA). There was no significant difference in performance between the two scores for predicting 30-day mortality (p=0.20) or need for ICU admission (p=0.09). Conclusion We recommend that ESS can be used in the UK population. It is non-inferior to NELA in predicting 30-day mortality and need for ICU admission, but has been validated for a wider range of outcomes and does not require scoring of intra-operative variables.

Emergency Surgery Score as an Effective Risk Stratification Tool for Patients Undergoing Emergency Surgeries: A Narrative Review.

Several risk stratification tools have been described for quantifying perioperative morbidity, mortality, and adverse events in patients undergoing elective and emergency surgeries. These tools help in decision-making, determining the prognosis and communicating it with patients and family members, and planning admissions to the intensive care units (ICU) if necessary. Emergency surgery poses quite a unique challenge in terms of deranged physiology, age, and comorbid conditions, and often carries a higher incidence of morbidity and mortality. Very few risk stratification tools are available to reliably predict the risk posed by emergency surgical interventions. One of the recently described tools is the Emergency Surgery Score (ESS), which comprises three demographic variables, 10 comorbidities, and nine laboratory variables, the scores of which add up to 29. Several studies have demonstrated that ESS reliably predicts morbidity, mortality, and the need for ICU admission, predicting infectious complications like pneumonia and renal failure. In this review, we analyze the current literature to investigate the efficacy and reliability of ESS as a risk stratification tool for patients undergoing emergency surgeries.

Performance of the Emergency Surgery Score for Nonelective Aortoiliac Endovascular Reconstructions

The Emergency Surgery Score (ESS) has been previously validated as a reliable tool to predict postoperative outcomes in emergency general surgeries and some vascular surgeries. The purpose of this study was to assess the performance of the ESS for endovascular aortoiliac revascularization procedures in the nonelective setting (neAER). The American College of Surgeons’ National Surgical Quality Improvement Program database was retrospectively analyzed for patients undergoing neAER between 2015 and 2019. The performance of the ESS in predicting mortality in each procedure was assessed using receiver operating characteristic analyses. A total of 838 patients underwent neAER with a median age of 65 (+11.99 standard deviation), with 400 females (47.7%). The 30-day mortality rate was 5.0%. The ESS correlated with 30-day mortality (area under the curve [AUC] was 0.786). The score gradually and accurately predicted 30-day mortality; 0%, 0.81%, 11.48%, 25%, and 100% of patients with ESS of 0, 4, 8, 12, and 16 died within 30 days after surgery, respectively. ESS was also used to calculate risk of death/discharge to hospice (AUC: 0.790), discharge to rehab (AUC: 0.686), renal failure (AUC: 0.715), reintubation (0.681), postintervention ventilation requirement (0.735), deep venous thrombosis (0.660), cardiopulmonary arrest (0.733), and septic shock (0.796). A cumulative frequency table of mortality with ESS was used to partition patients into quartiles of ESS <5, ESS of 6 or 7, ESS of 8 or 9, and ESS >10. A Cochran-Armitage test showed a linear trend toward increased 30-day mortality among the quartiles with increasing ESS (P < .001), with quartile 4 (ESS >10) having 76 times odds of increased 30-day mortality compared with reference quartile 1 (ESS <5) (Table). The correlation between the increasing ESS and observed 30-day mortality is displayed in the Fig. ESS performance accurately predicts mortality for neAER procedures. Its use may be useful for preoperative risk stratification and has the potential to be used for national benchmarking after these endovascular procedures.TableMultivariate analysis showing effects of predictors on 30-day mortalityVariableOdds ratioP valueSex (ref male)2.769.176Hispanic (ref not)0.000.998Preoperative ABI 0.9 or less (ref preoperative ABI >0.9)0.601.677Aortic stent1.808.638External iliac stent0.069.019CLTI (ref asx/claudicant)0.901.932High-risk anatomic factors1.715.485High-risk physiological factor1.642.517ESS score (ref score ≤5) 6 ≤ ESS ≤ 716.220.02 8 ≤ ESS ≤ 914.392.054 10 ≤ ESS76.252<.001C-statistic0.891Boldface type indicates statistical significance.ABI, Ankle-brachial index; CLTI, chronic limb-threatening ischemia; ESS, Emergency Surgery Score. Open table in a new tab

The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery.

Background: Unplanned return to the operating room (uROR) within the 30-day postoperative period can be used as a quality indicator in pediatric surgery. The aim of this study was to investigate and evaluate uROR as a quality indicator. Methods: The case records of pediatric patients who underwent reoperation within the 30-day period after primary surgery, from 1 January 2018 to 31 December 2020 were retrospectively reviewed. The primary outcome of the study was the rate of uROR as a quality indicator in pediatric surgery. Secondary outcomes were indications for primary and secondary surgery, types and management of complications, factors that led to uROR, length of hospital stay, duration of surgery and anesthesia, and starting time of surgery. Results: A total of 3982 surgical procedures, under general anesthesia, were performed during the three-year study period (2018, n = 1432; 2019, n = 1435; 2020, n = 1115). Elective and emergency surgeries were performed in 3032 (76.1%) and 950 (23.9%) patients, respectively. During the study period 19 (0.5%) pediatric patients, with the median age of 11 years (IQR 3, 16), underwent uROR within the 30-day postoperative period. The uROR incidence was 6 (0.4%), 6 (0.4%), and 7 (0.6%) for years 2018, 2019, and 2020, respectively (p = 0.697). The incidence of uROR was significantly higher in males (n = 14; 73.7%) than in females (n = 5; 26.3%) (p = 0.002). The share of unplanned reoperations in studied period was 4.5 times higher in primarily emergency surgeries compared to primarily elective surgeries (p < 0.001). The difference in incidence was 0.9% (95% CI, 0.4–1.4). Out of children that underwent uROR within the 30-day period after elective procedures, 50% had American Society of Anesthesiologists (ASA) score three or higher (p = 0.016). The most common procedure which led to uROR was appendectomy (n = 5, 26.3%) while the errors in surgical technique were the most common cause for uROR (n = 11, 57.9%). Conclusion: Unplanned reoperations within the 30-day period after the initial surgical procedure can be a good quality indicator in pediatric surgery. Risk factors associated with uROR are emergency surgery, male gender, and ASA score ≥3 in elective pediatric surgery.