Emergency Surgery Score as a Predictor of Post-operative Outcomes in Non-traumatic Emergency Laparotomy: A Prospective Observational Study

Introduction Most patients with acute abdominal conditions present with a unique set of problems because of acute physiological derangements, lack of optimization, and associated comorbidities. Emergency laparotomy in such patients is quite a morbid procedure. Predicting the surgical outcome and taking measures in advance to improve patient outcomes following emergency laparotomy is of utmost importance. Simultaneously, it can also help in preoperative counseling and shared decision-making for patient management. This study was designed to investigate the potential use of Emergency Surgery Score (ESS) in predicting outcomes among non-traumatic emergency laparotomy cases. Material and methods This prospective observational study was conducted at the Department of General Surgery at a Tertiary Care Centre in India. All patients above 18 years of age undergoing nontraumatic emergency laparotomy were included in the study. All variables related to the three broad categories of ESS were recorded. Each ESS variable was scored accordingly, except for the variable "White race," which was scored zero by default. Surgical outcome was recorded in terms of length of hospital stay, length of ICU stay, 30-day mortality rate, 30-day postoperative complications, and 30-day readmission. Results A total of 163 patients were included in this study. All the variables related to the ESS and surgical outcomes were recorded and analyzed. ESS correlated positively with the length of hospital and ICU stay among the survivors (rho=0.51 and rho=0.53, respectively). For a one-unit rise in ESS, the length of hospital stay and the length of ICU stay increased by 1.8 days and 0.71 days, respectively. Using Receiver Operating Characteristic (ROC) analysis, the ESS demonstrated a strong correlation with both the 30-day mortality rate and 30-day complications (Area under the Receiver Operating Characteristic Curve (AUROC) values of 0.895 and 0.875, respectively). Conclusion Our study's findings underscore the potential of ESS as a powerful predictor of postoperative outcomes in emergency laparotomies. By providing an objective measure for outcome comparison, ESS can significantly enhance preoperative patient counseling and decision-making.