The Emergency Surgery Score (ESS) accurately predicts the occurrence of postoperative complications in emergency surgery patients

Anirudh R. Nandan, Jordan D. Bohnen, Naveen F. Sangji, Thomas Peponis, Kelsey Han, D. Dante Yeh, Jarone Lee, Noelle Saillant, Marc De Moya, George C. Velmahos, David C. Chang, Haytham M.A. Kaafarani

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


BACKGROUND The Emergency Surgery Score (ESS) was recently validated as a scoring system to predict mortality in emergency surgery (ES) patients. We sought to examine the ability of ESS to predict the occurrence of 30-day postoperative complications in ES. METHODS The 2011-2012 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was screened for all surgical operations classified as "emergent." Thirty-day postoperative complications were defined as per ACS-NSQIP (e.g., surgical site infection, respiratory failure, acute renal failure). Each patient-related ESS was calculated, and the correlation between ESS and the probability of occurrence of 30-day postoperative complications was assessed by calculating the c-statistic. Univariate and multivariable models were also created to identify which ESS components independently predict complications. RESULTS Of 37,999 cases that captured all ESS variables, 14,446 (38%) resulted in at least one 30-day complication. The observed probability of a 30-day complication gradually increased from 7% to 53% to 91% at scores of 0, 7, and 15, respectively, with a c-statistic of 0.78. For ESS >15, the complication rate plateaued at a mean of 92%. On multivariable analyses, each of the 22 ESS components independently predicted the occurrence of postoperative complications. CONCLUSIONS ESS reliably predicts postoperative complications in ES patients. Such a score could prove useful for (1) perioperative patient and family counseling and (2) benchmarking the quality of ES care. LEVEL OF EVIDENCE Prognostic, level III.

Original languageEnglish (US)
Pages (from-to)84-89
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Issue number1
StatePublished - Jul 1 2017
Externally publishedYes


  • emergency surgery
  • Emergency surgery score
  • postoperative complications

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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