title: Estimation of physiologic ability and surgical stress (E-PASS) for a surgical audit in elective digestive surgery.
abstract: BACKGROUND
  This study was undertaken to establish an equation to estimate mortality with the use of the prediction scoring system designated as the Estimation of Physiologic Ability and Surgical Stress (E-PASS), and to evaluate the system's usefulness in defining quality of care by comparing it with the Physiologic and Operative Severity Score for the enUmeration for Mortality and morbidity (POSSUM) and Portsmouth-possum (P-POSSUM) scoring systems previously generated for surgical audit.
  
  
  METHODS
  Patients (n=5212; group A) who underwent elective gastrointestinal surgery were analyzed to establish equations for estimated 30-day and in-hospital mortality rates. The usefulness of E-PASS was evaluated in another series of 1934 patients (group B) who underwent elective digestive surgery in 6 national hospitals. The ratio of observed to estimated mortality rates (OE ratio) of each hospital was defined as a measure of quality.
  
  
  RESULTS
  In group A, 30-day and in-hospital mortality rates increased as the Comprehensive Risk Score (CRS) increased, providing equations for estimated mortality rates. There was an excellent correlation between the estimated and observed mortality rates in individual diseases: R=0.958, N=6, P=.0027 for in-hospital mortality; R=0.937, N=6, P=.0059 for 30-day mortality. In all patients of group B, the E-PASS system estimated the 30-day mortality rates by 0.63-fold (linear analysis), whereas the POSSUM score was 11.0-fold (exponential analysis). The E-PASS system estimated the in-hospital mortality rates by 1.2-fold (linear analysis), whereas the P-POSSUM score was 4.5-fold (linear analysis). The OE ratios for 30-day mortality among the 6 hospitals defined by E-PASS correlated well with those defined by POSSUM: R=0.996, N=6, P<.0001. Similarly, the OE ratios for in-hospital mortality defined by E-PASS were also highly correlated with those defined by P-POSSUM:(R=0.929, N=6, P=.0075.
  
  
  CONCLUSIONS
  The E-PASS scoring system may be useful in defining surgical quality and may be more accurate than existing systems in evaluating elective digestive surgery.
authors.affiliation: Department of Surgery, Kumamoto National Hospital, Ninomaru, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Haga
authors.forename: Y
authors.initials: Y
authors.lastname: Wada
authors.forename: H
authors.initials: H
authors.lastname: Takeuchi
authors.forename: O
authors.initials: O
authors.lastname: Kimura
authors.forename: T
authors.initials: T
authors.lastname: Furuya
authors.forename: H
authors.initials: H
authors.lastname: Sameshima
authors.forename: Masashi
authors.initials: M
authors.lastname: Ishikawa
mesh_terms: D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000592:standards*; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000592:standards*; D017052:Hospital Mortality; D006801:Humans; D008485:Medical Audit; D008962:Models, Theoretical; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care; D018570:Risk Assessment; D013312:Stress, Physiological / Q000209:etiology*