Emergency surgery score as a predictor of postoperative surgical site infection in patients undergoing emergency surgery for gastrointestinal diseases: A prospective cohort study

Abstract

Objectives: To measure the predictability of Emergency Surgery Score (ESS) in development of postoperative surgical site infections (SSIs) in emergency gastrointestinal surgery, during a period of 30 day follow up.

Methodology: In this prospective cohort study conducted at Patel Hospital between December 2023-January 2025, adults undergoing emergency gastrointestinal surgery for perforation, obstruction, inflammation, or ischemia were enrolled. Preoperative ESS was calculated. Patients with early mortality, extra-gastrointestinal infections, or immunocompromised status were excluded. The association between ESS and SSI was analyzed after a 30-day follow-up.

Results: Of fifty-six patients (median age 27.5 years; 69.6% male), the SSI incidence was 26.8% (n=15). Acute appendicitis (55.4%) was the most common diagnosis. SSI incidence rose significantly with ESS: 9.1% (ESS 0), 20% (ESS 1–3), and 70% (ESS 4–29). Logistic regression identified ESS 4–29 (OR: 23.3; p=0.028) and open procedures (OR: 23.1; p<0.001) as significant predictors. ROC analysis showed an Area under the Curve of 0.704 (p=0.008). An ESS cutoff of ≥3 provided 93% specificity and 47% sensitivity. Each 1-point ESS increase raised SSI odds by 1.45 times (95% CI: 1.11–1.90).

Conclusion: The ESS is a straightforward bedside tool that incorporates physiological and disease-related risk factors. An ESS cutoff of three or more showed high specificity, supporting its use for preoperative risk stratification and targeted infection prevention in emergency gastrointestinal surgery, especially in resource-limited settings.