title: Evaluation of modified estimation of physiologic ability and surgical stress in colorectal carcinoma surgery.
abstract: BACKGROUND
  We recently modified Estimation of Physiologic Ability and Surgical Stress, our prediction scoring system.
  
  
  OBJECTIVE
  This study evaluated the usefulness of our modified version for colorectal carcinoma in comparison with existing models.
  
  
  METHODS
  This investigation studied a multicenter cohort.
  
  
  METHODS
  The study was conducted in regional referral hospitals in Japan.
  
  
  METHODS
  Patients were included who underwent elective surgery for colorectal carcinoma.
  
  
  METHODS
  Postoperative morbidity, mortality, and predicted mortality rates for original and modified Estimation of Physiologic Ability and Surgical Stress were investigated in 2388 patients in comparison with existing European models.
  
  
  RESULTS
  Among the models, the modified Estimation of Physiologic Ability and Surgical Stress demonstrated the highest discriminatory power in terms of in-hospital mortality (area under receiver operating characteristic curve: 0.84 for Estimation of Physiologic Ability and Surgical Stress, 0.87 for modified Estimation of Physiologic Ability and Surgical Stress, 0.84 for Portsmouth modification of POSSUM, 0.74 for ASA status-based model), as well as 30-day mortality (area under receiver operating characteristic curve: 0.82 for Estimation of Physiologic Ability and Surgical Stress, 0.84 for modified Estimation of Physiologic Ability and Surgical Stress, 0.81 for POSSUM, 0.78 for colorectal POSSUM, 0.76 for Association of Coloproctology of Great Britain and Ireland score). British models, in general, overpredicted postoperative mortality rates by more than 10 times.
  
  
  CONCLUSIONS
  The current study analyzed only the Japanese population treated in medium-volume centers.
  
  
  CONCLUSIONS
  Among the models, modified Estimation of Physiologic Ability and Surgical Stress was the most accurate in predicting postoperative mortality in colorectal carcinoma surgery. These findings should be validated in Western populations, because the Japanese population may differ from Western populations in terms of body shape or reserve capacity.
authors: Institute for Clinical Research, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan. epass2006@ybb.ne.jp
authors: Yoshio
authors: Y
authors: Haga
authors: Yasuo
authors: Y
authors: Wada
authors: Masakazu
authors: M
authors: Ikenaga
authors: Hitoshi
authors: H
authors: Takeuchi
authors: Koji
authors: K
authors: Ikejiri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery*; D003110:Colonic Neoplasms / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D008962:Models, Theoretical; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care; D012004:Rectal Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult