Emergency Surgery Score (ESS) In Predicting Post- Operative Course In Patients Undergoing Emergency Laparotomy – An Indian Tertiary center experience

Abstract

Abstract Aims And Objectives - To determine the predictive value of Emergency Surgery Score (ESS) with regards to mortality and morbidity rates of patients undergoing emergency laparotomy. Method - The ESS, ranging from 0 to 29 is an extensive risk calculator based on 22 variables including important parameters like demographics, pre-operative 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. Results - 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 good predictor for development of postoperative LRTI (c-statistic = 0.828), sepsis (c-statistic = 0.867), DIC (c-statistic = 0.805), AKI (c-statistic = 0.804). ESS showed poor correlation with reoperation and readmission rates. Conclusion - It can be concluded from the study that risk stratification should be done for patients undergoing emergency laparotomy by using ESS. Thereby it can predict necessary needs for resuscitation and patient stabilization before surgery. Using ESS, patients unsuitable for operation can be identified and optimized beforehand; well informed decisions can be taken regarding targeted treatment, operation, and post-operative care. This study is a registered study under Clinical Trials Registry - India (CTRI) with registration number CTRI/2021/07/034504 and was registered on 01/07/2021.