Naveen F Sangji1,2, Jordan D Bohnen1, Elie P Ramly1, George C Velmahos1, David C Chang2, Haytham M A Kaafarani3,4. 1. Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA. 2. Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA. 3. Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA. hkaafarani@mgh.harvard.edu. 4. Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA. hkaafarani@mgh.harvard.edu.
Abstract
BACKGROUND: We present a novel and abbreviated Physiological Emergency Surgery Acuity Score (PESAS) that assesses the severity of disease at presentation in patients undergoing Emergency Surgery (ES). METHODS: Using the 2011 ACS-NSQIP database, we identified all patients who underwent "emergent" surgery. The following methodology was designed: (1) identification of independent predictors of 30-day mortality that are markers of acuity; (2) derivation of PESAS based on the relative impact (i.e., odds ratio) of each predictor; and (3) measurement of the c-statistic. The PESAS was validated using the 2012 ACS-NSQIP database. RESULTS: From 24,702 ES cases, a 15-point score was derived. This included 10 components with a range of 0 and 15 points. Its c-statistic was 0.80. Mortality gradually increased from 1.7 to 40.6 to 100% at scores of 0, 8, and 15, respectively. In the validation phase, PESAS c-statistic remained stable. CONCLUSION: PESAS is a novel score that assesses the acuity of disease at presentation in ES patients and strongly correlates with postoperative mortality risk. PESAS could prove useful for preoperative counseling and for risk-adjusted benchmarking.
BACKGROUND: We present a novel and abbreviated Physiological Emergency Surgery Acuity Score (PESAS) that assesses the severity of disease at presentation in patients undergoing Emergency Surgery (ES). METHODS: Using the 2011 ACS-NSQIP database, we identified all patients who underwent "emergent" surgery. The following methodology was designed: (1) identification of independent predictors of 30-day mortality that are markers of acuity; (2) derivation of PESAS based on the relative impact (i.e., odds ratio) of each predictor; and (3) measurement of the c-statistic. The PESAS was validated using the 2012 ACS-NSQIP database. RESULTS: From 24,702 ES cases, a 15-point score was derived. This included 10 components with a range of 0 and 15 points. Its c-statistic was 0.80. Mortality gradually increased from 1.7 to 40.6 to 100% at scores of 0, 8, and 15, respectively. In the validation phase, PESAS c-statistic remained stable. CONCLUSION: PESAS is a novel score that assesses the acuity of disease at presentation in ES patients and strongly correlates with postoperative mortality risk. PESAS could prove useful for preoperative counseling and for risk-adjusted benchmarking.
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