The Emergency Surgery Score accurately predicts the need for postdischarge respiratory and renal support after emergent laparotomies: A prospective EAST multicenter study
| Autor: | Zachary Chadnick, Jennifer Rodriquez, Daniel Cullinane, George E. Black, Georgia Vasileiou, José A. Díaz, Catherine G. Velopulos, Rachel L. Choron, Javier Martin Perez, Leon Naar, Haytham M.A. Kaafarani, Mirhee Kim, Heather Carmichael, Jeremy Badach, Georgios Tsoulfas, David Turay, Khaldoun Bekdache, Thomas Schroeppel, Napaporn Kongkaewpaisan, D. Dante Yeh, Marta L. McCrum, Cassandra Decker, Claire Hardman, Martin D. Zielinski, Firas Madbak, Majed El Hechi, Rishi Rattan, Brittany Aicher, Joseph V. Sakran, Daniel Steadman, Cory B. Emmert, Vasiliy Sim, Mbaga S. Walusimbi, Simon Rodier, Natalie Wall, Anna Goldenberg-Sandau, Thomas H. Shoultz, Lindsay O'Meara, Vasileios Papadopoulos, Maraya Camazine, Ursula J. Simonoski |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Critical Care and Intensive Care Medicine Risk Assessment Cohort Studies 03 medical and health sciences Postoperative Complications 0302 clinical medicine Predictive Value of Tests Renal Dialysis Epidemiology Post-hoc analysis Humans Medicine Medical diagnosis Respiratory system Dialysis Aged Laparotomy business.industry 030208 emergency & critical care medicine Evidence-based medicine Middle Aged medicine.disease Respiration Artificial Hospitalization Bowel obstruction Emergency medicine Female Surgery Observational study Emergency Service Hospital business Needs Assessment |
| Zdroj: | Journal of Trauma and Acute Care Surgery. 90:557-564 |
| ISSN: | 2163-0763 2163-0755 |
| DOI: | 10.1097/ta.0000000000003016 |
| Popis: | Background The Emergency Surgery Score (ESS) was recently validated as an accurate mortality risk calculator for emergency general surgery. We sought to prospectively evaluate whether ESS can predict the need for respiratory and/or renal support (RRS) at discharge after emergent laparotomies (EL). Methods This is a post hoc analysis of a 19-center prospective observational study. Between April 2018 and June 2019, all adult patients undergoing EL were enrolled. Preoperative, intraoperative, and postoperative variables were systematically collected. In this analysis, patients were excluded if they died during the index hospitalization, were discharged to hospice, or transferred to other hospitals. A composite variable, the need for RRS, was defined as the need for one or more of the following at hospital discharge: tracheostomy, ventilator dependence, or dialysis. Emergency Surgery Score was calculated for all patients, and the correlation between ESS and RRS was examined using the c-statistics method. Results From a total of 1,649 patients, 1,347 were included. Median age was 60 years, 49.4% were men, and 70.9% were White. The most common diagnoses were hollow viscus organ perforation (28.1%) and small bowel obstruction (24.5%); 87 patients (6.5%) had a need for RRS (4.7% tracheostomy, 2.7% dialysis, and 1.3% ventilator dependence). Emergency Surgery Score predicted the need for RRS in a stepwise fashion; for example, 0.7%, 26.2%, and 85.7% of patients required RRS at an ESS of 2, 12, and 16, respectively. The c-statistics for the need for RRS, the need for tracheostomy, ventilator dependence, or dialysis at discharge were 0.84, 0.82, 0.79, and 0.88, respectively. Conclusion Emergency Surgery Score accurately predicts the need for RRS at discharge in EL patients and could be used for preoperative patient counseling and for quality of care benchmarking. Level of evidence Prognostic and epidemiological, level III. |
| Databáze: | OpenAIRE |
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