Sangji et al reported the Emergency Surgery Acuity Socre (ESAS) to evaluate patients undergoing emergency surgery. The authors are from Massachusetts General Hospital.
Patient selection: emergency surgery
Parameters:
(1) age of the patient in years
(2) race
(3) transfer
(4) ascites
(5) body mass index in kg per square meter
(6) disseminated cancer
(7) dyspnea
(8) functional dependence
(9) history of COPD
(10) hypertension
(11) steroid use
(12) preoperative ventilator requirement within 48 hours of surgery
(13) weight loss in the preceding 6 months
(14) serum albumin in g/dL
(15) serum alkaline phosphatase in U/L
(16) serum BUN in mg/dL
(17) serum creatinine in mg/dL
(18) INR
(19) platelet count per µL
(20) serum SGOT in U/L
(21) serum sodium in mmol/L
(22) white blood cell count per µL
|
Parameter |
Finding |
Points |
|
age |
<= 60 years |
0 |
|
|
> 60 years |
2 |
|
race |
white |
1 |
|
|
non-white |
0 |
|
transfer |
none |
0 |
|
|
outside ED or acute care inpatient facility |
1 |
|
|
other |
0 |
|
ascites |
absent |
0 |
|
|
present |
1 |
|
body mass index |
< 20 kg per square meter |
1 |
|
|
>= 20 kg per sq m |
0 |
|
disseminated cancer |
absent |
0 |
|
|
present |
3 |
|
dyspnea |
absent |
0 |
|
|
present |
1 |
|
functional dependence |
absent |
0 |
|
|
present |
1 |
|
history of COPD |
absent |
0 |
|
|
present |
1 |
|
hypertension |
absent |
0 |
|
|
present |
1 |
|
steroid use |
absent |
0 |
|
|
present |
1 |
|
ventilator requirement |
absent |
0 |
|
|
present |
3 |
|
weight loss |
<= 10% |
0 |
|
|
> 10% |
1 |
|
serum albumin |
>= 3.0 g/dL |
0 |
|
|
< 3.0 g/dL |
1 |
|
serum alkaline phosphatase |
<= 125 U/L |
0 |
|
|
> 125 U/L |
1 |
|
serum BUN |
<= 40 mg/dL |
0 |
|
|
> 40 mg/dL |
1 |
|
serum creatinine |
<= 1.2 mg/dL |
0 |
|
|
> 1.2 mg/dL |
2 |
|
INR |
<= 1.5 |
0 |
|
|
> 1.5 |
1 |
|
serum SGOT |
<= 40 U/L |
0 |
|
|
> 40 U/L |
1 |
|
serum sodium |
<= 145 mmol/L |
0 |
|
|
> 145 mmol/L |
1 |
|
platelet count |
>= 150,000 per µL |
0 |
|
|
< 150,000 per µL |
1 |
|
WBC count |
< 4,500 per µL |
1 |
|
|
4,500 to 15,000 |
0 |
|
|
15,001 to 25,000 |
1 |
|
|
> 25,000 per µL |
2 |
total score =
= SUM(points for all 22 parameters)
Interpretation:
• minimum score: 0
• maximum score: 29
• The higher the score the greater the risk of 30-day postoperative complications.
|
Score |
30-Day Postoperative Complications |
|
0 |
6% |
|
1 |
9% |
|
3 |
20% |
|
5 |
40% |
|
8 |
60% |
|
12 |
80% |
|
15 |
90% |
from Figure 2, Nanden et al
Specialty: Anesthesiology, Surgery, general
