Khan M, et al. – Authors in this study determined factors associated with Failure–to–Rescue (FTR:death from major–complication) and devise simple–bedside–score that predicts FTR in emergency–general–surgery(EGS)–geriatric–patients(GP). They identified GRAS–score as first score based on preoperative assessment that could reliably predict FTR in EGS–GP. Preoperative identification of patients at increased–risk of FTR could provide help in risk–stratification and timely–mobilization of resources for successful rescue of these patients.

Methods

• Authors performed 3-year(2013–15) analysis of patients, age≥65y on acute-care-surgery-service and underwent EGS.
• They used regression analysis to determine factors associated with FTR and used natural-logarithm of significant odds-ratio to calculate estimated-weights for each factor.
• For each-patient, they calculated Geriatric-Rescue-After-Surgery(GRAS)-score.
• To assess model discrimination, they used AUROC.

Results

• Authors analyzed 725 EGS-patients.
• Major-complications were observed in 44.6%(n = 324).
• The FTR-rate of 11.5% was observed.
• Findings suggested overall-mortality rate of 15.3%.
• Regression analysis suggested significant-factors with their estimated-weights included:Age≥80y(2), Chronic-Obstructive-Pulmonary-Disease(COPD)(1), Chronic-renal-failure(CRF)(2), Congestive-heart-failure(CHF)(1), Albumin<3.5(1) and ASA score>3(2).
• In this study, AUROC of score was 0.787.