The Emergency Surgery Score (ESS) accurately predicts outcomes in elderly patients undergoing emergency general surgery

Abstract Purpose of Review The aim of this review is to explore the consequence of emergency general surgery in the elderly, and to summarise recent developments in the pre-, peri- and postoperative management of these patients, in order to improve outcomes. Recent Findings Preoperatively, accurate risk assessment is vital to ensure the right patients undergo emergency surgery. Perioperatively, there are multiple interventions specific to elderly patients that have been shown to improve outcomes. Postoperatively, elderly patients must be cared more in an appropriate setting in order to avoid failure to rescue and promote return to function. Summary This review of contemporary evidence identifies multiple pre-, peri- and postoperative interventions that can improve outcomes for elderly patients after emergency general surgery. These evidence-based recommendations should help direct care of elderly patients undergoing emergency surgery and foster further quality improvement measures and research investigations.

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Perioperative Factors Predicting Poor Outcome in Elderly Patients Following Emergency General Surgery: A Multivariate Analysis Study

Journal of Surgical Research ◽

10.1016/j.jss.2013.11.995 ◽

2014 ◽

Vol 186 (2) ◽

pp. 687

Author(s):

M. Lees ◽

S. Merani ◽

K. Tauh ◽

R.G. Khadaroo

Keyword(s):

Multivariate Analysis ◽

Elderly Patients ◽

General Surgery ◽

Emergency General Surgery ◽

Analysis Study ◽

Poor Outcome

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Would Dedicated Emergency Surgery Professionals Improve the Emergency General Surgery Service and Reduce the “Weekend Effect”?

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-018-3714-0 ◽

2018 ◽

Vol 22 (4) ◽

pp. 767-768

Author(s):

Arianna Birindelli ◽

R. Justin Davies ◽

Gregorio Tugnoli ◽

Fausto Catena ◽

Salomone Di Saverio

Keyword(s):

General Surgery ◽

Emergency Surgery ◽

Weekend Effect ◽

Emergency General Surgery

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Prospective validation of the Emergency Surgery Score in emergency general surgery: An Eastern Association for the Surgery of Trauma multicenter study

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002658 ◽

2020 ◽

Vol 89 (1) ◽

pp. 118-124 ◽

Cited By ~ 2

Author(s):

Haytham M.A. Kaafarani ◽

Napaporn Kongkaewpaisan ◽

Brittany O. Aicher ◽

Jose J. Diaz ◽

Lindsay B. O'Meara ◽

...

Keyword(s):

Multicenter Study ◽

General Surgery ◽

Emergency Surgery ◽

Emergency General Surgery

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1369 Clinical Outcomes in Patients Undergoing Emergency General Surgery During the Covid-19 Pandemic Versus Control Patients: A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab259.952 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

J Hebding ◽

L Wingfield ◽

Y Negreskul ◽

J Gilmour

Keyword(s):

Systematic Review ◽

Mortality Rate ◽

Hospital Stay ◽

General Surgery ◽

Complication Rate ◽

Emergency Surgery ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Emergency General Surgery ◽

Significant Difference

Abstract Introduction Throughout the Covid-19 pandemic, the surgical community has attempted to address whether it is safe to continue surgery. The aim of this research was to review evidence on emergency general patients operated on during the pandemic compared to patients undergoing emergency surgery during non-pandemic times to determine if operating during the Covid-19 pandemic led to an increased risk of death, length of hospital stay and complications. Method A systematic review of the literature was performed. PubMed, Cochrane, MEDLINE, Science Direct, Springer Link, Elsevier, and reference lists were analysed for inclusion on 2 January 2021. Results Nine studies and 5,022 patients were included. There were no significant differences in the control group vs pandemic group in mean age (52.3yrs vs 51.9yrs, p = 0.67) or gender (44.4% females vs 49.3%, p = 0.173). Pooled analysis of control vs pandemic showed a mortality rate of 1.26% vs 3.06% (CI:-6.58–6.58, p = 1.00). Mean length of hospital stay was 7.9 vs 7.7 days in control v. pandemic (CI: -2.93-3.33, p = 0.87) and post-operative complication rate of 20.2% vs 25.7% (CI -6.4-25.0, p = 0.20), (control vs pandemic). The pandemic group had significantly more operative management (47.0% vs 40.0%, p = 0.03) with no significant difference in laparoscopic vs open technique (46.0% vs 43.6%, p = 0.20). Conclusions This meta-analysis shows there is no statistically significant difference in mortality rate, length of hospital stay and postoperative complication rate between the pandemic and control cohorts in emergency general surgery patients. This data suggests that general emergency surgery should continue in spite of the pandemic with appropriate precautions in place.

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Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery

Surgery ◽

10.1016/j.surg.2017.11.017 ◽

2018 ◽

Vol 163 (4) ◽

pp. 832-838 ◽

Cited By ~ 14

Author(s):

Alexandra B. Columbus ◽

Megan A. Morris ◽

Elizabeth J. Lilley ◽

Alyssa F. Harlow ◽

Adil H. Haider ◽

...

Keyword(s):

Quality Improvement ◽

General Surgery ◽

Emergency Surgery ◽

Emergency General Surgery

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Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis

Canadian Journal of Surgery ◽

10.1503/cjs.011614 ◽

2015 ◽

Vol 58 (5) ◽

pp. 312-317 ◽

Cited By ~ 33

Author(s):

Mackenzie Lees ◽

Shaheed Merani ◽

Keerit Tauh ◽

Rachel Khadaroo

Keyword(s):

Regression Analysis ◽

Elderly Patients ◽

General Surgery ◽

Multivariate Regression ◽

Multivariate Regression Analysis ◽

Emergency General Surgery ◽

Poor Outcome

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Not a Routine Case, Why Expect the Routine Outcome? Quantifying the Infectious Burden of Emergency General Surgery Using the NSQIP

The American Surgeon ◽

10.1177/000313481908500943 ◽

2019 ◽

Vol 85 (9) ◽

pp. 1001-1009

Author(s):

Michael R. Arnold ◽

Angela M. Kao ◽

Kyle W. Cunningham ◽

A. Britton Christmas ◽

Bradley W. Thomas ◽

...

Keyword(s):

Ventral Hernia ◽

General Surgery ◽

Emergency Surgery ◽

Elective Surgery ◽

Emergency General Surgery ◽

Wound Classification ◽

Patient Responses ◽

Acs Nsqip Database ◽

Infectious Burden ◽

Emergent Surgery

Emergent surgeries have different causes and physiologic patient responses than the same elective surgery, many of which are due to infectious etiologies. Therefore, we hypothesized that emergency cases have a higher risk of postoperative SSI than their elective counterparts. The ACS NSQIP database was queried from 2005 to 2016 for all cholecystectomies, ventral hernia repairs, and partial colectomies to examine common emergency and elective general surgery operations. Thirty-day outcomes were compared by emergent status. Any SSI was the primary outcome. There were 863,164 surgeries: 416,497 cholecystectomies, 220,815 ventral hernia repairs, and 225,852 partial colectomies. SSIs developed in 38,865 (4.5%) patients. SSIs increased with emergencies (5.3% vs 3.6% for any SSI). Postoperative sepsis (5.8% vs 1.5%), septic shock (4.7% vs 0.6%), length of stay (8.1 vs 2.9 days), and mortality (3.6% vs 0.4%) were increased in emergent surgery; P < 0.001 for all. When controlling for age, gender, BMI, diabetes, smoking, wound classification, comorbidities, functional status, and procedure on multivariate analysis, emergency surgery (odds ratio 1.15, 95% confidence interval 1.11–1.19) was independently associated with the development of SSI. Patients undergoing emergency general surgery experience increased rates of SSI. Patients and their families should be appropriately counseled regarding these elevated risks when consenting for emergency surgery.

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