Derivation and Validation of a Novel Physiological Emergency Surgery Acuity Score (PESAS)
- 224 Downloads
We present a novel and abbreviated Physiological Emergency Surgery Acuity Score (PESAS) that assesses the severity of disease at presentation in patients undergoing Emergency Surgery (ES).
Using the 2011 ACS-NSQIP database, we identified all patients who underwent “emergent” surgery. The following methodology was designed: (1) identification of independent predictors of 30-day mortality that are markers of acuity; (2) derivation of PESAS based on the relative impact (i.e., odds ratio) of each predictor; and (3) measurement of the c-statistic. The PESAS was validated using the 2012 ACS-NSQIP database.
From 24,702 ES cases, a 15-point score was derived. This included 10 components with a range of 0 and 15 points. Its c-statistic was 0.80. Mortality gradually increased from 1.7 to 40.6 to 100% at scores of 0, 8, and 15, respectively. In the validation phase, PESAS c-statistic remained stable.
PESAS is a novel score that assesses the acuity of disease at presentation in ES patients and strongly correlates with postoperative mortality risk. PESAS could prove useful for preoperative counseling and for risk-adjusted benchmarking.
KeywordsReceiver Operating Curve Stepwise Logistic Regression Model Derivation Cohort Physiological Derangement Risk Calculator Tool
We thank Dr. Matthew Hutter (Department of Surgery, Massachusetts General Hospital and Director, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital) and Ms. Donna Antonelli (Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital) for their guidance in utilizing the ACS-NSQIP database.
Drs. NFS, JAB, EPR, DCC, and HMAK contributed to study design. Drs. NFS, JAB, EPR, DCC, and HMAK collected the data. Drs. NFS, JAB, EPR, DCC, and HMAK helped in data analysis/interpretation. Drs. NFS, JAB, EPR, DCC, and HMAK analyzed the data statistically. Literature search was performed by Dr. NFS. Drs. NFS, JAB, EPR, DCC, HMAK, and GCV wrote and critically revised the manuscript.
Compliance with ethical standards
Conflict of interest
We have no conflicts of interest to report.
- 20.ACS NSQIP (2012) User guide for the 2012 ACS NSQIP participant use data fileGoogle Scholar
- 21.ACS NSQIP (2011) User guide for the 2011 participant use data fileGoogle Scholar
- 22.ACS NSQIP, Data Collection, Analysis, and ReportingGoogle Scholar
- 23.ACS NSQIP, About ACS NSQIPGoogle Scholar