• Thamer Nouh, Norah Alkadi, Lamis Alsuwailem, Albatoul Alshanaifi, Rahaf Alshunaiber, and Ahmed Alburakan.
• Trauma and Acute Care Surgery Unit, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia. tnouh@ksu.edu.sa.
• Eur J Trauma Emerg Surg. 2023 Jun 1; 49 (3): 132113271321-1327.

PurposeEmergency surgery carries an increased risk of death and complications. Scoring systems can help identify patients at higher risk of mortality and complications. Scoring systems can also help benchmark acute care services. This study aims to compare different scoring systems in predicting outcomes among acute care surgery patients.MethodsOur study is a retrospective cohort study that included all adult emergency surgery admissions between 2017 and 2019. Data were obtained from patients' electronic health records. Same admission mortality and postoperative complications were collected. Data were recorded to calculate the American Society of Anesthesiologists Physical Status classification system (ASA-PS), Shock Index Score (SI), Age Shock Index Score (AgeSI), and the Emergency Surgery Score (ESS). The probability of death and complications was correlated with each scoring system and was assessed by calculating the c-statistic.ResultsDuring the study period, 1606 patients fulfilled inclusion criteria. The mortality rate was 2.2%, complication rate was 18.7%. ESS predicted mortality with a c-statistic of 0.87 better than ASA-PS, AgeSI, and SI with a calculated c-statistic of 0.81, 0.74, and 0.57, respectively. ESS also predicted the occurrence of complications with a c-statistic of 0.83 better than ASA-PS, AgeSI, and SI with a calculated c-statistic of 0.72, 0.71, and 0.63, respectively.ConclusionESS demonstrated a better prognostic accuracy for hospital mortality and postoperative complications than other prognostic scoring systems. Our findings suggest that a scoring system designed for the acute care surgical population may provide enhanced prognostic performance over other surgical prognostic scoring systems.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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