title: Estimation of physiologic ability and surgical stress score does not predict immediate outcome after pancreatic surgery.
abstract: OBJECTIVE
  The Estimation of Physiologic Ability and Surgical Stress score was designed to predict postoperative morbidity and mortality in general surgery. Our study aims to evaluate its use and accuracy in estimating postoperative outcome after elective pancreatic surgery.
  
  
  METHODS
  Between 2002 and 2007, approximately 304 patients requiring pancreatic resection at our institution were recorded prospectively and evaluated retrospectively. The patients' preoperative risk score, surgical stress score (SSS), and comprehensive risk score (CRS) were calculated and compared with the severity of postoperative morbidity, where mortality was regarded as the most severe postoperative complication.
  
  
  RESULTS
  Observed and predicted mortality rates were 2.9% and 2.0%, respectively. Mean CRS was higher in patients who died than in patients that survived, but this difference was not statistically significant (P = 0.20). Preoperative risk score, SSS, and CRS did not differ between patients with and without complications (preoperative risk score: P = 0.32; SSS: P = 0.22; CRS: P = 0.13). Estimation of Physiologic Ability and Surgical Stress particularly underpredicted morbidity in patients with a CRS between 0.0 and less than 0.5.
  
  
  CONCLUSIONS
  The Estimation of Physiologic Ability and Surgical Stress scoring system is an ineffective predictor of complications after pancreatic resection. Further refinements to the score calculation are warranted to provide accurate prediction of immediate surgical outcome after pancreatic surgery.
authors.affiliation: Department of Visceral Surgery and Medicine, Inselspital, University Hospital Berne and University of Berne, Berne, Switzerland.
authors.forename: Simone
authors.initials: S
authors.lastname: Deyle
authors.forename: Vanessa Martine
authors.initials: VM
authors.lastname: Banz
authors.forename: Markus
authors.initials: M
authors.lastname: Wagner
authors.forename: Karin
authors.initials: K
authors.lastname: Becker
authors.forename: Daniel
authors.initials: D
authors.lastname: Inderbitzin
authors.forename: Beat
authors.initials: B
authors.lastname: Gloor
authors.forename: Daniel
authors.initials: D
authors.lastname: Candinas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000503:physiopathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013312:Stress, Physiological; D016896:Treatment Outcome; D055815:Young Adult