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Performance Of The Emergency Surgery Score (ESS) For Non Elective Infrainguinal Open Revascularization Procedures (NEIOR)
Naveen Balasundaram1, *Vishruth Thagahalli Sunil Kumar1, *Shubham Kanake1, *Sadhvika Ramji2, *Isaiah Chandra1, *TODD R VOGEL1
1University of Missouri, Columbia, MO;2Cleveland Clinic Foundation, Cleveland, OH

OBJECTIVE(S):Background: The Emergency Surgery Score (ESS) has been previously validated as a reliable tool to predict postoperative outcomes in emergency general surgery. The purpose of this study was to assess the performance of the ESS for non-elective infrainguinal open revascularization procedures (NEIOR). METHODS: The American College of Surgeonsí National Surgical Quality Improvement Program database was retrospectively analyzed for patients undergoing NEIOR between 2015 and 2019. The performance of the ESS in predicting mortality in each procedure was assessed using receiver operating characteristic analyses.
RESULTS: 5027 patients underwent NEIOR with median age 68 (+ 11.66 SD), with 1666 females (33.1%). The 30-day mortality rate was 2.7%. The ESS correlated with 30-day mortality (C-statistic 0.738), discharge to rehab (0.643), Renal failure (0.741) and stroke (0.717). Thirty day mortality was 0%, 1.30%, 7.34% and 44.4% for patients with ESS of 0, 4, 8 and 12, respectively. A cumulative frequency table of mortality with ESS was used to partition patients into quartiles of ESS < 5, ESS of 6, ESS of 7 or 8, and ESS > 9. A Cochran- Armitage test showed linear trend towards increased 30-day mortality among the quartiles (seen in Figure 1) with increasing ESS (p<0.001), with Quartile 4 (ESS>9) having 13 times odds of increased 30-day mortality compared to reference quartile 1 (ESS<5) (Table 1).
CONCLUSIONS: ESS performance accurately predicts mortality for NEIOR procedures. Its use may be useful for preoperative risk stratification and has the potential to be utilized for national benchmarking after lower extremity endovascular procedures

Multivariate analysis with effects of predictors on 30 day mortality
VariableOdds Ratiop - value
Prosthetic/ Spliced/ Composite (ref Single segment GSV)0.9130.742
Tibial target (ref popliteal target)0.9680.905
Chronic Limb Threatening Ischemia (CLTI) (ref asymptomatic/ claudicant)1.7250.377
High Risk Anatomic factors1.460.168
High Risk Physiological factors5.308<0.001
ESS score (ref score <5)ESS = 64.749<0.001
7<ESS<84.076<0.001
9<ESS12.602<0.001
C - statistic0.843


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