Derivation and Validation of a Novel Physiological Emergency Surgery Acuity Score (PESAS)

Abstract

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.