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Haytham M A Kaafarani - One of the best experts on this subject based on the ideXlab platform.
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validation of the Emergency Surgery score ess in a greek patient population a prospective bi institutional cohort study
European Journal of Trauma and Emergency Surgery, 2021Co-Authors: Chrysanthos D Christou, George C Velmahos, Leon Naar, Napaporn Kongkaewpaisan, Alexandros Tsolakidis, Panagiotis Smyrnis, Andreas Tooulias, Georgios Tsoulfas, Vasileios Papadopoulos, Haytham M A KaafaraniAbstract:The Emergency Surgery Score (ESS) is a reliable point-based score that predicts mortality and morbidity in Emergency Surgery patients. However, it has been validated only in the U.S. patients. We aimed to prospectively validate ESS in a Greek patient population. All patients who underwent an emergent laparotomy were prospectively included over a 15-month period. A systematic chart review was performed to collect relevant preoperative, intraoperative, and postoperative variables based on which the ESS was calculated for each patient. The relationship between ESS and 30-day mortality, morbidity (i.e., the occurrence of at least one complication), and the need for intensive care unit (ICU) admission was evaluated and compared between the Greek and U.S. patients using the c-statistics methodology. The study was registered on "Research Registry" with the unique identifying number 5901. A total of 214 patients (102 Greek) were included. The mean age was 64 years, 44% were female, and the median ESS was 7. The most common indication for Surgery was hollow viscus perforation (25%). The ESS reliably and incrementally predicted mortality (c-statistics = 0.79 [95% CI 0.67–0.90] and 0.83 [95% CI 0.74–0.92]), morbidity (c-statistics = 0.83 [95% CI 0.76–0.91] and 0.79 [95% CI 0.69–0.88]), and ICU admission (c-statistics = 0.88 [95% CI 0.81–0.96] and 0.84 [95% CI 0.77–0.91]) in both Greek and U.S. patients. The correlation between the ESS and the surgical outcomes was statistically significant in both Greek and U.S. patients undergoing Emergency laparotomy. ESS could prove globally useful for preoperative patient counseling and quality-of-care benchmarking.
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the Emergency Surgery score is a powerful predictor of outcomes across multiple surgical specialties results of a retrospective nationwide analysis
Surgery, 2021Co-Authors: Reem Alsowaiegh, Mohamad El Moheb, George C Velmahos, Leon Naar, Jonathan Parks, Jason Fawley, April E Mendoza, Noelle Saillant, Haytham M A KaafaraniAbstract:BACKGROUND The Emergency Surgery Score was recently validated in a prospective multicenter study as an accurate predictor of mortality in Emergency general Surgery patients. The Emergency Surgery Score is easily calculated using multiple demographic, comorbidity, laboratory, and acuity of disease variables. We aimed to investigate whether the Emergency Surgery Score can predict 30-day postoperative mortality across patients undergoing Emergency Surgery in multiple surgical specialties. METHODS Our study is a retrospective cohort study using data from the national American College of Surgeons National Surgical Quality Improvement Program database (2007-2017). We included patients that underwent Emergency gynecologic, urologic, thoracic, neurosurgical, orthopedic, vascular, cardiac, and general surgical procedures. The Emergency Surgery Score was calculated for each patient, and the correlation between the Emergency Surgery Score and 30-day mortality was assessed for each specialty using the c-statistics methodology. RESULTS Of 6,485,915 patients, 173,890 patients were included. The mean age was 60 years, 50.6% were female patients, and the overall mortality was 9.7%. The Emergency Surgery Score predicted mortality best in Emergency gynecologic, general, and urologic Surgery (c-statistics: 0.97, 0.87, 0.81, respectively). The Emergency Surgery Score predicted mortality moderately well in Emergency thoracic, neurosurgical, orthopedic, and vascular Surgery (c-statistics 0.73-0.79). For example, the mortality of gynecology patients with an Emergency Surgery Score of 5, 9, and 13 was 2%, 27%, and 50%, respectively. The Emergency Surgery Score performed poorly in cardiac Surgery. CONCLUSION The Emergency Surgery Score accurately predicts mortality across patients undergoing Emergency Surgery in multiple surgical specialties, especially general, gynecologic, and urologic Surgery. The Emergency Surgery Score can prove useful for perioperative patient counseling and for benchmarking the quality of surgical care.
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validation of the artificial intelligence based predictive optimal trees in Emergency Surgery risk potter calculator in Emergency general Surgery and Emergency laparotomy patients
Journal of The American College of Surgeons, 2021Co-Authors: Majed El Hechi, Lydia R Maurer, Jordan Levine, Daisy Zhuo, Mohamad El Moheb, George C Velmahos, Jack Dunn, Dimitris Bertsimas, Haytham M A KaafaraniAbstract:ABSTRACT Introduction The Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) tool is an Artificial Intelligence (AI)-based calculator for the prediction of 30-day outcomes in Emergency Surgery patients. In this study, we sought to assess the performance of POTTER in the Emergency General Surgery (EGS) population in particular. Methods All patients who underwent EGS in the 2017 ACS-NSQIP database were included. The performance of POTTER in predicting 30-day postoperative mortality, morbidity, and 18 specific complications was assessed using the c-statistic metric. As a subgroup analysis, the performance of POTTER in predicting the outcomes of patients undergoing Emergency Laparotomy (EL) was assessed. Results A total of 59,955 patients were included. Median age was 50 and 51.3% were females. POTTER predicted mortality (c-statistic=0.93) and morbidity (c-statistic=0.83) extremely well. Among individual complications, POTTER had the highest performance in predicting septic shock (c-statistic=0.93), respiratory failure requiring mechanical ventilation for ≥48 hours (c-statistic=0.92), and acute renal failure (c-statistic=0.92). Among EL patients, the c-statistic performances of POTTER in predicting mortality and morbidity were 0.86 and 0.77, respectively. Conclusions POTTER is an interpretable, accurate, and user-friendly predictor of 30-day outcomes in patients undergoing EGS. POTTER could prove useful for bedside counseling of patients and their families and for benchmarking of EGS care.
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validation of the artificial intelligence based predictive optimal trees in Emergency Surgery risk potter calculator in Emergency general Surgery and Emergency laparotomy patients
Journal of The American College of Surgeons, 2021Co-Authors: Majed El Hechi, Lydia R Maurer, Jordan Levine, Daisy Zhuo, Mohamad El Moheb, George C Velmahos, Jack Dunn, Dimitris Bertsimas, Haytham M A KaafaraniAbstract:Background The Predictive Optimal Trees in Emergency Surgery Risk (POTTER) tool is an artificial intelligence-based calculator for the prediction of 30-day outcomes in patients undergoing Emergency operations. In this study, we sought to assess the performance of POTTER in the Emergency general Surgery (EGS) population in particular. Methods All patients who underwent EGS in the 2017 American College of Surgeons NSQIP database were included. The performance of POTTER in predicting 30-day postoperative mortality, morbidity, and 18 specific complications was assessed using the c-statistic metric. As a subgroup analysis, the performance of POTTER in predicting the outcomes of patients undergoing Emergency laparotomy was assessed. Results A total of 59,955 patients were included. Median age was 50 years and 51.3% were women. POTTER predicted mortality (c-statistic = 0.93) and morbidity (c-statistic = 0.83) extremely well. Among individual complications, POTTER had the highest performance in predicting septic shock (c-statistic = 0.93), respiratory failure requiring mechanical ventilation for 48 hours or longer (c-statistic = 0.92), and acute renal failure (c-statistic = 0.92). Among patients undergoing Emergency laparotomy, the c-statistic performances of POTTER in predicting mortality and morbidity were 0.86 and 0.77, respectively. Conclusions POTTER is an interpretable, accurate, and user-friendly predictor of 30-day outcomes in patients undergoing EGS. POTTER could prove useful for bedside counseling of patients and their families and for benchmarking of EGS care.
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does the Emergency Surgery score predict failure to discharge the patient home a nationwide analysis
Journal of Trauma-injury Infection and Critical Care, 2021Co-Authors: Reem Alsowaiegh, George C Velmahos, Leon Naar, Jonathan Parks, Jason Fawley, April E Mendoza, Noelle Saillant, Ava Mokhtari, Haytham M A KaafaraniAbstract:BACKGROUND The Emergency Surgery Score (ESS) is a point-based scoring system validated to predict mortality and morbidity in Emergency general Surgery (EGS). In addition to demographics and comorbidities, ESS accounts for the acuity of disease at presentation. We sought to examine whether ESS can predict the destination of discharge of EGS patients, as a proxy for quality of life at discharge. METHODS Using the 2007 to 2017 American College of Surgeons National Surgical Quality Improvement Program database, we identified all EGS patients. EGS cases were defined as per American College of Surgeons National Surgical Quality Improvement Program as those performed by a general surgeon within a short interval from diagnosis or the onset of related symptomatology, when the patient's well-being and outcome may be threatened by unnecessary delay and patient's status could deteriorate unpredictably or rapidly. Emergency Surgery Score patients were then categorized by their discharge disposition to home versus rehabilitation or nursing facilities. All patients with missing ESS or discharge disposition and those discharged to hospice, senior communities, or separate acute care facilities were excluded. Emergency Surgery Score was calculated for each patient. C statistics were used to study the correlation between ESS and the destination of discharge. RESULTS Of 6,485,915 patients, 84,694 were included. The mean age was 57 years, 51% were female, and 79.6% were discharged home. The mean ESS was 5. Emergency Surgery Score accurately and reliably predicted the discharge destination with a C statistic of 0.83. For example, ESS of 1, 10, and 20 were associated with 0.9%, 56.5%, and 100% rates of discharge to a rehabilitation or nursing facility instead of home. CONCLUSION Emergency Surgery Score accurately predicts which EGS patients require discharge to rehabilitation or nursing facilities and can thus be used for preoperatively counseling patients and families and for improving early discharge preparations, when appropriate. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
George C Velmahos - One of the best experts on this subject based on the ideXlab platform.
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validation of the Emergency Surgery score ess in a greek patient population a prospective bi institutional cohort study
European Journal of Trauma and Emergency Surgery, 2021Co-Authors: Chrysanthos D Christou, George C Velmahos, Leon Naar, Napaporn Kongkaewpaisan, Alexandros Tsolakidis, Panagiotis Smyrnis, Andreas Tooulias, Georgios Tsoulfas, Vasileios Papadopoulos, Haytham M A KaafaraniAbstract:The Emergency Surgery Score (ESS) is a reliable point-based score that predicts mortality and morbidity in Emergency Surgery patients. However, it has been validated only in the U.S. patients. We aimed to prospectively validate ESS in a Greek patient population. All patients who underwent an emergent laparotomy were prospectively included over a 15-month period. A systematic chart review was performed to collect relevant preoperative, intraoperative, and postoperative variables based on which the ESS was calculated for each patient. The relationship between ESS and 30-day mortality, morbidity (i.e., the occurrence of at least one complication), and the need for intensive care unit (ICU) admission was evaluated and compared between the Greek and U.S. patients using the c-statistics methodology. The study was registered on "Research Registry" with the unique identifying number 5901. A total of 214 patients (102 Greek) were included. The mean age was 64 years, 44% were female, and the median ESS was 7. The most common indication for Surgery was hollow viscus perforation (25%). The ESS reliably and incrementally predicted mortality (c-statistics = 0.79 [95% CI 0.67–0.90] and 0.83 [95% CI 0.74–0.92]), morbidity (c-statistics = 0.83 [95% CI 0.76–0.91] and 0.79 [95% CI 0.69–0.88]), and ICU admission (c-statistics = 0.88 [95% CI 0.81–0.96] and 0.84 [95% CI 0.77–0.91]) in both Greek and U.S. patients. The correlation between the ESS and the surgical outcomes was statistically significant in both Greek and U.S. patients undergoing Emergency laparotomy. ESS could prove globally useful for preoperative patient counseling and quality-of-care benchmarking.
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the Emergency Surgery score is a powerful predictor of outcomes across multiple surgical specialties results of a retrospective nationwide analysis
Surgery, 2021Co-Authors: Reem Alsowaiegh, Mohamad El Moheb, George C Velmahos, Leon Naar, Jonathan Parks, Jason Fawley, April E Mendoza, Noelle Saillant, Haytham M A KaafaraniAbstract:BACKGROUND The Emergency Surgery Score was recently validated in a prospective multicenter study as an accurate predictor of mortality in Emergency general Surgery patients. The Emergency Surgery Score is easily calculated using multiple demographic, comorbidity, laboratory, and acuity of disease variables. We aimed to investigate whether the Emergency Surgery Score can predict 30-day postoperative mortality across patients undergoing Emergency Surgery in multiple surgical specialties. METHODS Our study is a retrospective cohort study using data from the national American College of Surgeons National Surgical Quality Improvement Program database (2007-2017). We included patients that underwent Emergency gynecologic, urologic, thoracic, neurosurgical, orthopedic, vascular, cardiac, and general surgical procedures. The Emergency Surgery Score was calculated for each patient, and the correlation between the Emergency Surgery Score and 30-day mortality was assessed for each specialty using the c-statistics methodology. RESULTS Of 6,485,915 patients, 173,890 patients were included. The mean age was 60 years, 50.6% were female patients, and the overall mortality was 9.7%. The Emergency Surgery Score predicted mortality best in Emergency gynecologic, general, and urologic Surgery (c-statistics: 0.97, 0.87, 0.81, respectively). The Emergency Surgery Score predicted mortality moderately well in Emergency thoracic, neurosurgical, orthopedic, and vascular Surgery (c-statistics 0.73-0.79). For example, the mortality of gynecology patients with an Emergency Surgery Score of 5, 9, and 13 was 2%, 27%, and 50%, respectively. The Emergency Surgery Score performed poorly in cardiac Surgery. CONCLUSION The Emergency Surgery Score accurately predicts mortality across patients undergoing Emergency Surgery in multiple surgical specialties, especially general, gynecologic, and urologic Surgery. The Emergency Surgery Score can prove useful for perioperative patient counseling and for benchmarking the quality of surgical care.
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validation of the artificial intelligence based predictive optimal trees in Emergency Surgery risk potter calculator in Emergency general Surgery and Emergency laparotomy patients
Journal of The American College of Surgeons, 2021Co-Authors: Majed El Hechi, Lydia R Maurer, Jordan Levine, Daisy Zhuo, Mohamad El Moheb, George C Velmahos, Jack Dunn, Dimitris Bertsimas, Haytham M A KaafaraniAbstract:ABSTRACT Introduction The Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) tool is an Artificial Intelligence (AI)-based calculator for the prediction of 30-day outcomes in Emergency Surgery patients. In this study, we sought to assess the performance of POTTER in the Emergency General Surgery (EGS) population in particular. Methods All patients who underwent EGS in the 2017 ACS-NSQIP database were included. The performance of POTTER in predicting 30-day postoperative mortality, morbidity, and 18 specific complications was assessed using the c-statistic metric. As a subgroup analysis, the performance of POTTER in predicting the outcomes of patients undergoing Emergency Laparotomy (EL) was assessed. Results A total of 59,955 patients were included. Median age was 50 and 51.3% were females. POTTER predicted mortality (c-statistic=0.93) and morbidity (c-statistic=0.83) extremely well. Among individual complications, POTTER had the highest performance in predicting septic shock (c-statistic=0.93), respiratory failure requiring mechanical ventilation for ≥48 hours (c-statistic=0.92), and acute renal failure (c-statistic=0.92). Among EL patients, the c-statistic performances of POTTER in predicting mortality and morbidity were 0.86 and 0.77, respectively. Conclusions POTTER is an interpretable, accurate, and user-friendly predictor of 30-day outcomes in patients undergoing EGS. POTTER could prove useful for bedside counseling of patients and their families and for benchmarking of EGS care.
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validation of the artificial intelligence based predictive optimal trees in Emergency Surgery risk potter calculator in Emergency general Surgery and Emergency laparotomy patients
Journal of The American College of Surgeons, 2021Co-Authors: Majed El Hechi, Lydia R Maurer, Jordan Levine, Daisy Zhuo, Mohamad El Moheb, George C Velmahos, Jack Dunn, Dimitris Bertsimas, Haytham M A KaafaraniAbstract:Background The Predictive Optimal Trees in Emergency Surgery Risk (POTTER) tool is an artificial intelligence-based calculator for the prediction of 30-day outcomes in patients undergoing Emergency operations. In this study, we sought to assess the performance of POTTER in the Emergency general Surgery (EGS) population in particular. Methods All patients who underwent EGS in the 2017 American College of Surgeons NSQIP database were included. The performance of POTTER in predicting 30-day postoperative mortality, morbidity, and 18 specific complications was assessed using the c-statistic metric. As a subgroup analysis, the performance of POTTER in predicting the outcomes of patients undergoing Emergency laparotomy was assessed. Results A total of 59,955 patients were included. Median age was 50 years and 51.3% were women. POTTER predicted mortality (c-statistic = 0.93) and morbidity (c-statistic = 0.83) extremely well. Among individual complications, POTTER had the highest performance in predicting septic shock (c-statistic = 0.93), respiratory failure requiring mechanical ventilation for 48 hours or longer (c-statistic = 0.92), and acute renal failure (c-statistic = 0.92). Among patients undergoing Emergency laparotomy, the c-statistic performances of POTTER in predicting mortality and morbidity were 0.86 and 0.77, respectively. Conclusions POTTER is an interpretable, accurate, and user-friendly predictor of 30-day outcomes in patients undergoing EGS. POTTER could prove useful for bedside counseling of patients and their families and for benchmarking of EGS care.
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does the Emergency Surgery score predict failure to discharge the patient home a nationwide analysis
Journal of Trauma-injury Infection and Critical Care, 2021Co-Authors: Reem Alsowaiegh, George C Velmahos, Leon Naar, Jonathan Parks, Jason Fawley, April E Mendoza, Noelle Saillant, Ava Mokhtari, Haytham M A KaafaraniAbstract:BACKGROUND The Emergency Surgery Score (ESS) is a point-based scoring system validated to predict mortality and morbidity in Emergency general Surgery (EGS). In addition to demographics and comorbidities, ESS accounts for the acuity of disease at presentation. We sought to examine whether ESS can predict the destination of discharge of EGS patients, as a proxy for quality of life at discharge. METHODS Using the 2007 to 2017 American College of Surgeons National Surgical Quality Improvement Program database, we identified all EGS patients. EGS cases were defined as per American College of Surgeons National Surgical Quality Improvement Program as those performed by a general surgeon within a short interval from diagnosis or the onset of related symptomatology, when the patient's well-being and outcome may be threatened by unnecessary delay and patient's status could deteriorate unpredictably or rapidly. Emergency Surgery Score patients were then categorized by their discharge disposition to home versus rehabilitation or nursing facilities. All patients with missing ESS or discharge disposition and those discharged to hospice, senior communities, or separate acute care facilities were excluded. Emergency Surgery Score was calculated for each patient. C statistics were used to study the correlation between ESS and the destination of discharge. RESULTS Of 6,485,915 patients, 84,694 were included. The mean age was 57 years, 51% were female, and 79.6% were discharged home. The mean ESS was 5. Emergency Surgery Score accurately and reliably predicted the discharge destination with a C statistic of 0.83. For example, ESS of 1, 10, and 20 were associated with 0.9%, 56.5%, and 100% rates of discharge to a rehabilitation or nursing facility instead of home. CONCLUSION Emergency Surgery Score accurately predicts which EGS patients require discharge to rehabilitation or nursing facilities and can thus be used for preoperatively counseling patients and families and for improving early discharge preparations, when appropriate. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
Majed El Hechi - One of the best experts on this subject based on the ideXlab platform.
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the Emergency Surgery score ess and outcomes in elderly patients undergoing Emergency laparotomy a post hoc analysis of an east multicenter study
American Journal of Surgery, 2021Co-Authors: Majed El Hechi, Mohamad El Moheb, Napaporn Kongkaewpaisan, Brittany O Aicher, Jose J Diaz, Cassandra Decker, Jennifer Rodriquez, Thomas J Schroeppel, Lindsay Oʼmeara, Rishi RattanAbstract:Abstract Introduction We sought to evaluate whether the Emergency Surgery Score (ESS) can accurately predict outcomes in elderly patients undergoing emergent laparotomy (EL). Methods This is a post-hoc analysis of an EAST multicenter study. Between April 2018 and June 2019, all adult patients undergoing EL in 19 participating hospitals were prospectively enrolled, and ESS was calculated for each patient. Using the c-statistic, the correlation between ESS and mortality, morbidity, and need for ICU admission was assessed in three patient age cohorts (65–74, 75–84, ≥85 years old). Results 715 patients were included, of which 52% were 65–74, 34% were 75–84, and 14% were ≥85 years old; 51% were female, and 77% were white. ESS strongly correlated with postoperative mortality (c-statistic:0.81). Mortality gradually increased from 0% to 20%–60% at ESS of 2, 10 and 16 points, respectively. ESS predicted mortality, morbidity, and need for ICU best in patients 65–74 years old (c-statistic:0.81, 0.75, 0.83 respectively), but its performance significantly decreased in patients ≥85 years (c-statistic:0.72, 0.64, 0.67 respectively). Conclusion ESS is an accurate predictor of outcome in the elderly EL patient 65–85 years old, but its performance decreases for patients ≥85. Consideration should be given to modify ESS to better predict outcomes in the very elderly patient population.
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validation of the artificial intelligence based predictive optimal trees in Emergency Surgery risk potter calculator in Emergency general Surgery and Emergency laparotomy patients
Journal of The American College of Surgeons, 2021Co-Authors: Majed El Hechi, Lydia R Maurer, Jordan Levine, Daisy Zhuo, Mohamad El Moheb, George C Velmahos, Jack Dunn, Dimitris Bertsimas, Haytham M A KaafaraniAbstract:ABSTRACT Introduction The Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) tool is an Artificial Intelligence (AI)-based calculator for the prediction of 30-day outcomes in Emergency Surgery patients. In this study, we sought to assess the performance of POTTER in the Emergency General Surgery (EGS) population in particular. Methods All patients who underwent EGS in the 2017 ACS-NSQIP database were included. The performance of POTTER in predicting 30-day postoperative mortality, morbidity, and 18 specific complications was assessed using the c-statistic metric. As a subgroup analysis, the performance of POTTER in predicting the outcomes of patients undergoing Emergency Laparotomy (EL) was assessed. Results A total of 59,955 patients were included. Median age was 50 and 51.3% were females. POTTER predicted mortality (c-statistic=0.93) and morbidity (c-statistic=0.83) extremely well. Among individual complications, POTTER had the highest performance in predicting septic shock (c-statistic=0.93), respiratory failure requiring mechanical ventilation for ≥48 hours (c-statistic=0.92), and acute renal failure (c-statistic=0.92). Among EL patients, the c-statistic performances of POTTER in predicting mortality and morbidity were 0.86 and 0.77, respectively. Conclusions POTTER is an interpretable, accurate, and user-friendly predictor of 30-day outcomes in patients undergoing EGS. POTTER could prove useful for bedside counseling of patients and their families and for benchmarking of EGS care.
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validation of the artificial intelligence based predictive optimal trees in Emergency Surgery risk potter calculator in Emergency general Surgery and Emergency laparotomy patients
Journal of The American College of Surgeons, 2021Co-Authors: Majed El Hechi, Lydia R Maurer, Jordan Levine, Daisy Zhuo, Mohamad El Moheb, George C Velmahos, Jack Dunn, Dimitris Bertsimas, Haytham M A KaafaraniAbstract:Background The Predictive Optimal Trees in Emergency Surgery Risk (POTTER) tool is an artificial intelligence-based calculator for the prediction of 30-day outcomes in patients undergoing Emergency operations. In this study, we sought to assess the performance of POTTER in the Emergency general Surgery (EGS) population in particular. Methods All patients who underwent EGS in the 2017 American College of Surgeons NSQIP database were included. The performance of POTTER in predicting 30-day postoperative mortality, morbidity, and 18 specific complications was assessed using the c-statistic metric. As a subgroup analysis, the performance of POTTER in predicting the outcomes of patients undergoing Emergency laparotomy was assessed. Results A total of 59,955 patients were included. Median age was 50 years and 51.3% were women. POTTER predicted mortality (c-statistic = 0.93) and morbidity (c-statistic = 0.83) extremely well. Among individual complications, POTTER had the highest performance in predicting septic shock (c-statistic = 0.93), respiratory failure requiring mechanical ventilation for 48 hours or longer (c-statistic = 0.92), and acute renal failure (c-statistic = 0.92). Among patients undergoing Emergency laparotomy, the c-statistic performances of POTTER in predicting mortality and morbidity were 0.86 and 0.77, respectively. Conclusions POTTER is an interpretable, accurate, and user-friendly predictor of 30-day outcomes in patients undergoing EGS. POTTER could prove useful for bedside counseling of patients and their families and for benchmarking of EGS care.
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can the Emergency Surgery score ess predict outcomes in Emergency general Surgery patients with missing data elements a nationwide analysis
American Journal of Surgery, 2020Co-Authors: Leon Naar, Majed El Hechi, George C Velmahos, Jonathan Parks, Jason Fawley, April E Mendoza, Noelle Saillant, Nikolaos Kokoroskos, Haytham M A KaafaraniAbstract:Abstract Background The Emergency Surgery Score (ESS) is an accurate mortality risk calculator for Emergency general Surgery (EGS). We sought to assess whether ESS can accurately predict 30-day morbidity, mortality, and requirement for postoperative Intensive Care Unit (ICU) care in patients with missing data variables. Methods All EGS patients with one or more missing ESS variables in the 2007–2015 ACS-NSQIP database were included. ESS was calculated assuming that a missing variable is normal (i.e. no additional ESS points). The correlation between ESS and morbidity, mortality, and postoperative ICU level of care was assessed using the c-statistics methodology. Results Out of a total of 4,456,809 patients, 359,849 were EGS, and of those 256,278 (71.2%) patients had at least one ESS variable missing. ESS correlated extremely well with mortality (c-statistic = 0.94) and postoperative requirement of ICU care (c-statistic = 0.91) and well with morbidity (c-statistic = 0.77). Conclusion ESS performs well in predicting outcomes in EGS patients even when one or more data elements are missing and remains a useful bedside tool for counseling EGS patients and for benchmarking the quality of EGS care.
Mohamad El Moheb - One of the best experts on this subject based on the ideXlab platform.
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the Emergency Surgery score is a powerful predictor of outcomes across multiple surgical specialties results of a retrospective nationwide analysis
Surgery, 2021Co-Authors: Reem Alsowaiegh, Mohamad El Moheb, George C Velmahos, Leon Naar, Jonathan Parks, Jason Fawley, April E Mendoza, Noelle Saillant, Haytham M A KaafaraniAbstract:BACKGROUND The Emergency Surgery Score was recently validated in a prospective multicenter study as an accurate predictor of mortality in Emergency general Surgery patients. The Emergency Surgery Score is easily calculated using multiple demographic, comorbidity, laboratory, and acuity of disease variables. We aimed to investigate whether the Emergency Surgery Score can predict 30-day postoperative mortality across patients undergoing Emergency Surgery in multiple surgical specialties. METHODS Our study is a retrospective cohort study using data from the national American College of Surgeons National Surgical Quality Improvement Program database (2007-2017). We included patients that underwent Emergency gynecologic, urologic, thoracic, neurosurgical, orthopedic, vascular, cardiac, and general surgical procedures. The Emergency Surgery Score was calculated for each patient, and the correlation between the Emergency Surgery Score and 30-day mortality was assessed for each specialty using the c-statistics methodology. RESULTS Of 6,485,915 patients, 173,890 patients were included. The mean age was 60 years, 50.6% were female patients, and the overall mortality was 9.7%. The Emergency Surgery Score predicted mortality best in Emergency gynecologic, general, and urologic Surgery (c-statistics: 0.97, 0.87, 0.81, respectively). The Emergency Surgery Score predicted mortality moderately well in Emergency thoracic, neurosurgical, orthopedic, and vascular Surgery (c-statistics 0.73-0.79). For example, the mortality of gynecology patients with an Emergency Surgery Score of 5, 9, and 13 was 2%, 27%, and 50%, respectively. The Emergency Surgery Score performed poorly in cardiac Surgery. CONCLUSION The Emergency Surgery Score accurately predicts mortality across patients undergoing Emergency Surgery in multiple surgical specialties, especially general, gynecologic, and urologic Surgery. The Emergency Surgery Score can prove useful for perioperative patient counseling and for benchmarking the quality of surgical care.
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the Emergency Surgery score ess and outcomes in elderly patients undergoing Emergency laparotomy a post hoc analysis of an east multicenter study
American Journal of Surgery, 2021Co-Authors: Majed El Hechi, Mohamad El Moheb, Napaporn Kongkaewpaisan, Brittany O Aicher, Jose J Diaz, Cassandra Decker, Jennifer Rodriquez, Thomas J Schroeppel, Lindsay Oʼmeara, Rishi RattanAbstract:Abstract Introduction We sought to evaluate whether the Emergency Surgery Score (ESS) can accurately predict outcomes in elderly patients undergoing emergent laparotomy (EL). Methods This is a post-hoc analysis of an EAST multicenter study. Between April 2018 and June 2019, all adult patients undergoing EL in 19 participating hospitals were prospectively enrolled, and ESS was calculated for each patient. Using the c-statistic, the correlation between ESS and mortality, morbidity, and need for ICU admission was assessed in three patient age cohorts (65–74, 75–84, ≥85 years old). Results 715 patients were included, of which 52% were 65–74, 34% were 75–84, and 14% were ≥85 years old; 51% were female, and 77% were white. ESS strongly correlated with postoperative mortality (c-statistic:0.81). Mortality gradually increased from 0% to 20%–60% at ESS of 2, 10 and 16 points, respectively. ESS predicted mortality, morbidity, and need for ICU best in patients 65–74 years old (c-statistic:0.81, 0.75, 0.83 respectively), but its performance significantly decreased in patients ≥85 years (c-statistic:0.72, 0.64, 0.67 respectively). Conclusion ESS is an accurate predictor of outcome in the elderly EL patient 65–85 years old, but its performance decreases for patients ≥85. Consideration should be given to modify ESS to better predict outcomes in the very elderly patient population.
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validation of the artificial intelligence based predictive optimal trees in Emergency Surgery risk potter calculator in Emergency general Surgery and Emergency laparotomy patients
Journal of The American College of Surgeons, 2021Co-Authors: Majed El Hechi, Lydia R Maurer, Jordan Levine, Daisy Zhuo, Mohamad El Moheb, George C Velmahos, Jack Dunn, Dimitris Bertsimas, Haytham M A KaafaraniAbstract:ABSTRACT Introduction The Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) tool is an Artificial Intelligence (AI)-based calculator for the prediction of 30-day outcomes in Emergency Surgery patients. In this study, we sought to assess the performance of POTTER in the Emergency General Surgery (EGS) population in particular. Methods All patients who underwent EGS in the 2017 ACS-NSQIP database were included. The performance of POTTER in predicting 30-day postoperative mortality, morbidity, and 18 specific complications was assessed using the c-statistic metric. As a subgroup analysis, the performance of POTTER in predicting the outcomes of patients undergoing Emergency Laparotomy (EL) was assessed. Results A total of 59,955 patients were included. Median age was 50 and 51.3% were females. POTTER predicted mortality (c-statistic=0.93) and morbidity (c-statistic=0.83) extremely well. Among individual complications, POTTER had the highest performance in predicting septic shock (c-statistic=0.93), respiratory failure requiring mechanical ventilation for ≥48 hours (c-statistic=0.92), and acute renal failure (c-statistic=0.92). Among EL patients, the c-statistic performances of POTTER in predicting mortality and morbidity were 0.86 and 0.77, respectively. Conclusions POTTER is an interpretable, accurate, and user-friendly predictor of 30-day outcomes in patients undergoing EGS. POTTER could prove useful for bedside counseling of patients and their families and for benchmarking of EGS care.
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validation of the artificial intelligence based predictive optimal trees in Emergency Surgery risk potter calculator in Emergency general Surgery and Emergency laparotomy patients
Journal of The American College of Surgeons, 2021Co-Authors: Majed El Hechi, Lydia R Maurer, Jordan Levine, Daisy Zhuo, Mohamad El Moheb, George C Velmahos, Jack Dunn, Dimitris Bertsimas, Haytham M A KaafaraniAbstract:Background The Predictive Optimal Trees in Emergency Surgery Risk (POTTER) tool is an artificial intelligence-based calculator for the prediction of 30-day outcomes in patients undergoing Emergency operations. In this study, we sought to assess the performance of POTTER in the Emergency general Surgery (EGS) population in particular. Methods All patients who underwent EGS in the 2017 American College of Surgeons NSQIP database were included. The performance of POTTER in predicting 30-day postoperative mortality, morbidity, and 18 specific complications was assessed using the c-statistic metric. As a subgroup analysis, the performance of POTTER in predicting the outcomes of patients undergoing Emergency laparotomy was assessed. Results A total of 59,955 patients were included. Median age was 50 years and 51.3% were women. POTTER predicted mortality (c-statistic = 0.93) and morbidity (c-statistic = 0.83) extremely well. Among individual complications, POTTER had the highest performance in predicting septic shock (c-statistic = 0.93), respiratory failure requiring mechanical ventilation for 48 hours or longer (c-statistic = 0.92), and acute renal failure (c-statistic = 0.92). Among patients undergoing Emergency laparotomy, the c-statistic performances of POTTER in predicting mortality and morbidity were 0.86 and 0.77, respectively. Conclusions POTTER is an interpretable, accurate, and user-friendly predictor of 30-day outcomes in patients undergoing EGS. POTTER could prove useful for bedside counseling of patients and their families and for benchmarking of EGS care.
Napaporn Kongkaewpaisan - One of the best experts on this subject based on the ideXlab platform.
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validation of the Emergency Surgery score ess in a greek patient population a prospective bi institutional cohort study
European Journal of Trauma and Emergency Surgery, 2021Co-Authors: Chrysanthos D Christou, George C Velmahos, Leon Naar, Napaporn Kongkaewpaisan, Alexandros Tsolakidis, Panagiotis Smyrnis, Andreas Tooulias, Georgios Tsoulfas, Vasileios Papadopoulos, Haytham M A KaafaraniAbstract:The Emergency Surgery Score (ESS) is a reliable point-based score that predicts mortality and morbidity in Emergency Surgery patients. However, it has been validated only in the U.S. patients. We aimed to prospectively validate ESS in a Greek patient population. All patients who underwent an emergent laparotomy were prospectively included over a 15-month period. A systematic chart review was performed to collect relevant preoperative, intraoperative, and postoperative variables based on which the ESS was calculated for each patient. The relationship between ESS and 30-day mortality, morbidity (i.e., the occurrence of at least one complication), and the need for intensive care unit (ICU) admission was evaluated and compared between the Greek and U.S. patients using the c-statistics methodology. The study was registered on "Research Registry" with the unique identifying number 5901. A total of 214 patients (102 Greek) were included. The mean age was 64 years, 44% were female, and the median ESS was 7. The most common indication for Surgery was hollow viscus perforation (25%). The ESS reliably and incrementally predicted mortality (c-statistics = 0.79 [95% CI 0.67–0.90] and 0.83 [95% CI 0.74–0.92]), morbidity (c-statistics = 0.83 [95% CI 0.76–0.91] and 0.79 [95% CI 0.69–0.88]), and ICU admission (c-statistics = 0.88 [95% CI 0.81–0.96] and 0.84 [95% CI 0.77–0.91]) in both Greek and U.S. patients. The correlation between the ESS and the surgical outcomes was statistically significant in both Greek and U.S. patients undergoing Emergency laparotomy. ESS could prove globally useful for preoperative patient counseling and quality-of-care benchmarking.
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the Emergency Surgery score ess and outcomes in elderly patients undergoing Emergency laparotomy a post hoc analysis of an east multicenter study
American Journal of Surgery, 2021Co-Authors: Majed El Hechi, Mohamad El Moheb, Napaporn Kongkaewpaisan, Brittany O Aicher, Jose J Diaz, Cassandra Decker, Jennifer Rodriquez, Thomas J Schroeppel, Lindsay Oʼmeara, Rishi RattanAbstract:Abstract Introduction We sought to evaluate whether the Emergency Surgery Score (ESS) can accurately predict outcomes in elderly patients undergoing emergent laparotomy (EL). Methods This is a post-hoc analysis of an EAST multicenter study. Between April 2018 and June 2019, all adult patients undergoing EL in 19 participating hospitals were prospectively enrolled, and ESS was calculated for each patient. Using the c-statistic, the correlation between ESS and mortality, morbidity, and need for ICU admission was assessed in three patient age cohorts (65–74, 75–84, ≥85 years old). Results 715 patients were included, of which 52% were 65–74, 34% were 75–84, and 14% were ≥85 years old; 51% were female, and 77% were white. ESS strongly correlated with postoperative mortality (c-statistic:0.81). Mortality gradually increased from 0% to 20%–60% at ESS of 2, 10 and 16 points, respectively. ESS predicted mortality, morbidity, and need for ICU best in patients 65–74 years old (c-statistic:0.81, 0.75, 0.83 respectively), but its performance significantly decreased in patients ≥85 years (c-statistic:0.72, 0.64, 0.67 respectively). Conclusion ESS is an accurate predictor of outcome in the elderly EL patient 65–85 years old, but its performance decreases for patients ≥85. Consideration should be given to modify ESS to better predict outcomes in the very elderly patient population.
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prospective validation of the Emergency Surgery score in Emergency general Surgery an eastern association for the Surgery of trauma multicenter study
Journal of Trauma-injury Infection and Critical Care, 2020Co-Authors: Haytham M A Kaafarani, Napaporn Kongkaewpaisan, Brittany O Aicher, Jose J Diaz, Lindsay Omeara, Cassandra Decker, Jennifer Rodriquez, Thomas J Schroeppel, Rishi Rattan, Georgia VasileiouAbstract:Background The Emergency Surgery Score (ESS) was recently developed and retrospectively validated as an accurate mortality risk calculator for Emergency general Surgery. We sought to prospectively validate ESS, specifically in the high-risk nontrauma Emergency laparotomy (EL) patient. Methods This is an Eastern Association for the Surgery of Trauma multicenter prospective observational study. Between April 2018 and June 2019, 19 centers enrolled all adults (aged >18 years) undergoing EL. Preoperative, intraoperative, and postoperative variables were prospectively and systematically collected. Emergency Surgery Score was calculated for each patient and validated using c-statistic methodology by correlating it with three postoperative outcomes: (1) 30-day mortality, (2) 30-day complications (e.g., respiratory/renal failure, infection), and (3) postoperative intensive care unit (ICU) admission. Results A total of 1,649 patients were included. The mean age was 60.5 years, 50.3% were female, and 71.4% were white. The mean ESS was 6, and the most common indication for EL was hollow viscus perforation. The 30-day mortality and complication rates were 14.8% and 53.3%; 57.0% of patients required ICU admission. Emergency Surgery Score gradually and accurately predicted 30-day mortality; 3.5%, 50.0%, and 85.7% of patients with ESS of 3, 12, and 17 died after Surgery, respectively, with a c-statistic of 0.84. Similarly, ESS gradually and accurately predicted complications; 21.0%, 57.1%, and 88.9% of patients with ESS of 1, 6, and 13 developed postoperative complications, with a c-statistic of 0.74. Emergency Surgery Score also accurately predicted which patients required intensive care unit admission (c-statistic, 0.80). Conclusion This is the first prospective multicenter study to validate ESS as an accurate predictor of outcome in the EL patient. Emergency Surgery Score can prove useful for (1) perioperative patient and family counseling, (2) triaging patients to the intensive care unit, and (3) benchmarking the quality of Emergency general Surgery care. Level of evidence Prognostic study, level III.
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the Emergency Surgery score ess accurately predicts outcomes in elderly patients undergoing Emergency general Surgery
American Journal of Surgery, 2020Co-Authors: Apostolos Gaitanidis, George C Velmahos, Jonathan Parks, Jason Fawley, April E Mendoza, Noelle Saillant, Napaporn Kongkaewpaisan, Sarah Mikdad, Kerry Breen, Haytham M A KaafaraniAbstract:Abstract Background The performance of the Emergency Surgery Score (ESS), a validated risk calculator, in the elderly Emergency general Surgery (EGS) patient remains unclear. We hypothesized that ESS accurately predicts outcomes in elderly EGS patients, including octogenarians and nonagenarians. Methods Using the 2007–2017 National Surgical Quality Improvement Program (NSQIP) database, we included all EGS patients ≥65 years old. The correlation between ESS, mortality and morbidity was assessed in the 3 patient cohorts (>65, octogenarians and nonagenarians), using the area under the curve (AUC). Results A total of 124,335 patients were included, of which 34,215 (28%) were octogenarians and 7239 (6%) were nonagenarians. In patients ≥65 years, ESS accurately predicted mortality (AUC 0.81). For octogenarians and nonagenarians, ESS predicted mortality moderately well (AUC 0.77 and 0.69, respectively. Conclusion ESS accurately predicts mortality and morbidity in the elderly EGS patient, but its accuracy in predicting morbidity decreases for nonagenarians.
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Emergency Surgery score accurately predicts the risk of post operative infection in Emergency general Surgery
Surgical Infections, 2019Co-Authors: Kelsey Han, Jae Moo Lee, Aditya Achanta, Napaporn Kongkaewpaisan, Manasnun Kongwibulwut, Ahmed Eid, Nikolaos Kokoroskos, Suzanne Van Wijck, Karien Meier, Ask T NordestgaardAbstract:Abstract Background: The Emergency Surgery Score (ESS) was validated recently as an accurate and user-friendly post-operative mortality risk calculator specific for Emergency General Surgery (EGS)....