K. E. Singer1, M. C. Morris1, S. Tompkins1, A. S. Lanich1, T. A. Pritts1, M. D. Goodman1 1University Of Cincinnati,Surgery,Cincinnati, OH, USA
Introduction: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk calculator is widely used in general surgery for stratifying patients’ risk of post-operative morbidity and mortality. However, the formula was designed for elective surgery and therefore, the Emergency Surgery Score (ESS) was created to predict risk in the emergent setting. Unlike NSQIP, ESS does not distinguish amongst potential types of postoperative complications. We sought to elucidate whether these two scoring systems can be correlated in an effort to better understand the types of morbidities the ESS may predict.
Methods: The Acute Care Surgery database at a large, academic medical center was queried to identify patients who underwent cholecystectomy over a two-year period. ACS-NSQIP Surgical Risk Score and ESS were subsequently calculated based on their individual parameters. Spearman correlation for ESS and each NSQIP complication score was performed using JMP software (SAS Institute Inc., NC).
Results: Three hundred and ninety-five patients were identified. The majority of patients were white (55.9%), women (72.1%) with a median BMI of 31 kg/m2 and age of 42 years. Ninety-five percent of cases were laparoscopic and 55% were done emergently. ESS correlated with each NSQIP complication with moderate strength for cardiac complications, discharge to rehabilitation, as well as for developing pneumonia and renal failure. The scores were only weakly correlated for surgical site infection and death. In subgroup analysis between urgent versus elective cholecystectomy, a slight increase in correlation was observed in urgent cholecystectomy (Table 1).
Conclusion: The ESS and NSQIP scores demonstrate correlation for postoperative morbidities. However, there is variability in the strength of correlation. These correlations may also be dependent upon type of operation proposed and potentially other physiologic parameters not included in these scoring systems, such as vasopressor requirement. Utilization of these perioperative risk calculators may help to appropriately guide preoperative patient counseling and family discussions.
