Validation of Emergency Surgery Score (ESS) as outcome prediction score in Egyptian patients undergoing emergency laparotomy

Background: Emergency laparotomy is an exploratory procedure for many surgical situations. Proper prognostic prediction helps recognize high-risk patients who benefit from further therapy. The Emergency Surgery Score (ESS) was developed as a preoperative risk evaluation assessment that predicts patient outcomes after emergency laparotomy. Objective: This study is to validate the ESS in Egyptian patients by evaluating its predictive ability for 30-day mortality, surgical complications, and ICU admission rates. Methods: This prospective observational cohort study was performed out from May 2022 to November 2023 at two tertiary centers in Egypt. Patients aged 18 and above undergoing emergency laparotomy were included, whereas pregnant women and individuals with vascular or gynecological indications were eliminated. Preoperative, intraoperative, and postoperative data were thoroughly collected, and ESS was calculated for all patients. The primary desired outcome was 30-day death, while secondary outcomes included surgical complications and ICU admission. Standard definitions from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were used. Results: This study included a diverse cohort, with a mean age of the patients 48.66±19.37 years. The 30-day totally mortality rate was 28%. The most common complication was pneumonia (60%), followed by sepsis and acute kidney injury. Higher ESS scores were significantly associated with increased mortality and complication rates, confirming its predictive validity. Conclusion: ESS effectively categorized Egyptian patients who more reliable to complications of emergency laparotomy. Its use may improve clinical decision-making, optimize resource allocation, and facilitate patient and family counseling. Further research is recommended to refine its applicability across different populations. ClinicalTrials.gov ID : NCT05639920 registration date on (26/10/2021)