title: Validation of the estimation of physiologic ability and surgical stress (E-PASS) score in liver surgery.
abstract: BACKGROUND
  The estimation of physiologic ability and surgical stress (E-PASS) has been used to produce a numerical estimate of expected mortality and morbidity after elective gastrointestinal surgery. The aim of this study was to validate E-PASS in a selected cohort of patients requiring liver resections (LR).
  
  
  METHODS
  In this retrospective study, E-PASS predictor equations for morbidity and mortality were applied to the prospective data from 243 patients requiring LR. The observed rates were compared with predicted rates using Fisher's exact test. The discriminative capability of E-PASS was evaluated using receiver-operating characteristic (ROC) curve analysis.
  
  
  RESULTS
  The observed and predicted overall mortality rates were both 3.3% and the morbidity rates were 31.3 and 26.9%, respectively. There was a significant difference in the comprehensive risk scores for deceased and surviving patients (p = 0.043). However, the scores for patients with or without complications were not significantly different (p = 0.120). Subsequent ROC curve analysis revealed a poor predictive accuracy for morbidity.
  
  
  CONCLUSIONS
  The E-PASS score seems to effectively predict mortality in this specific group of patients but is a poor predictor of complications. A new modified logistic regression might be required for LR in order to better predict the postoperative outcome.
authors.affiliation: Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, CH-3010, Bern, Switzerland. vanessa.banz@gmx.ch
authors.forename: Vanessa M
authors.initials: VM
authors.lastname: Banz
authors.forename: Peter
authors.initials: P
authors.lastname: Studer
authors.forename: Daniel
authors.initials: D
authors.lastname: Inderbitzin
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013312:Stress, Physiological; D055815:Young Adult