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)

• Published in: BMJ open Vol. 12; no. 11; p. e061781
• Main Authors: Raffee, Liqaa, Almasarweh, Sami A, Mazahreh, Tagleb S, Alawneh, Khaled, Alabdallah, Nadeem Bilal, AL Hamoud, Mohammad A, Aburayya, Hamza A, Ayoub, Fadi S, Issa, Fadi, Ciottone, Greg
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 18-11-2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: accident & emergency medicine; adult surgery; Age; Ascites; Body mass index; Chronic obstructive pulmonary disease; Creatinine; Critical care; Data collection; Decision making; Dyspnea; Emergency medical care; Hospitals; Hypertension; Laboratories; Medical prognosis; Morbidity; Mortality; Patients; Phosphatase; Postoperative period; Quality improvement; Steroids; Surgery; Ventilators; Jordan (country)
• DOI: 10.1136/bmjopen-2022-061781
• EISSN: 2044-6055

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 in the Jordanian surgical population.DesignA retrospective validation study.SettingA tertiary hospital in Jordan.ParticipantsA database was created including patients who underwent emergent surgery in King Abdullah University Hospital from January 2017 to June 2021.Primary and secondary outcome measuresRelevant preoperative, intraoperative and postoperative variables were retrospectively and systematically gathered, and the ESS was calculated for each patient accordingly. In addition, a multivariable logistic regression analysis was performed to assess the correlations between the ESS and postoperative mortality and morbidity along with intensive care unit (ICU) admissions.ResultsOut of total of 1452 patients evaluated, 1322 patients were enrolled based on inclusion and exclusion criteria. The mean age of the population was 47.9 years old. 91.9% of the patients were admitted to the surgical ward through the emergency department, while the rest were referred from inpatient and outpatient facilities. The mortality and postoperative complication rates were 3.9% and 13.5%, respectively. Mortality rates increased as the ESS score gradually increased, and the ESS was evaluated as a strong predictor with a c-statistic value of 0.842 (95% CI 0.743 to 0.896). The postoperative complication and ICU admission rate also increased with reciprocal rises in the ESS. They were also evaluated as accurate predictors with a c-statistic value of 0.724 (95% CI 0.682 to 0.765) and a c-statistic value of 0.825 (95% CI 0.784 to 0.866), respectively.ConclusionThe ESS is a robust, accurate predictor of postoperative mortality and morbidity of emergency general surgery patients. Furthermore, it is an all-important tool to enhance emergency general surgery practices, in terms of mitigating risk, quality of care measures and patient counselling.