Evaluation of an Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system to predict postoperative risk: a multicenter prospective study.
We previously reported generating a scoring system termed E-PASS that predicted postsurgical risk. This study was undertaken to evaluate the usefulness of this system. A consecutive series of 902 patients who underwent elective gastrointestinal operations in six national hospitals in Japan were prospectively assessed for a comprehensive risk score (CRS) of the E-PASS, which was compared with their postoperative course. The postoperative morbidity rates linearly increased as the CRS increased. The postoperative mortality rate was only 0.13%, when the CRS was below 0.5; however, it increased to 9.7% when the CRS ranged from 0.5 to <1.0, and to 26.9% when the CRS was > or =1.0. The CRS correlated significantly with the severity of postoperative complications (rs = 0.527, P < 0.0001) and the costs of hospital stay (rs = 0.810, P < 0.0001). When the CRS-adjusted mortality rate at the CRS of > or =0.5 was compared among the hospitals, it was related to the hospital volume of operations, being 44.2% at the volume of <100 cases per year, 20.6% at the range of 100-199 cases, and 8.6% at the volume of > or =200 cases. These results suggest that E-PASS may be useful for predicting postsurgical risk, estimating medical expense, and comparing surgical quality.
Haga
Y
Y
Department of Surgery, Kumamoto National Hospital, Japan.
Ikei
S
S
Wada
Y
Y
Takeuchi
H
H
Sameshima
H
H
Kimura
O
O
Furuya
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002648:Child; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D015203:Reproducibility of Results; D012107:Research Design; D012307:Risk Factors; D013312:Stress, Physiological; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data