title: E-PASS score as a useful predictor of postoperative complications and mortality after colorectal surgery in elderly patients.
abstract: OBJECTIVE
  The aim of this study was to clarify whether a surgical-specific risk scoring system estimating the physiologic ability and surgical stress (E-PASS) score was useful for prediction of postoperative morbidity and mortality.
  
  
  METHODS
  The E-PASS score consists of the preoperative risk score (PRS), surgical stress score (SSS), and the comprehensive risk score (CRS). Conventional scoring systems [colorectal physiologic and operative severity score for the enumeration of mortality (CR-POSSUM) and the prognostic nutritional index (PNI)] were also examined. We retrospectively compared these scores in patients with or without postoperative complications. We assessed the relationship between these scores, clinicopathological features and postoperative mortality.
  
  
  RESULTS
  Postoperative complications developed in 78 patients (33%). American Society of Anesthesiologists score, performance status, PNI score, PRS, SSS, and CRS were significantly higher in patients with postoperative complications than in those without postoperative complications (p < 0.05). The area under the receiver operating characteristic curve (AUC) was highest for E-PASS [E-PASS (PRS, 0.74; SSS, 0.62; CRS, 0.78), PNI (0.62), CR-POSSUM (PS, 0.57; OSS, 0.52)]. Multivariate logistic analysis identified CRS ≥ 0.2 as a significant determinant of postoperative complications (p < 0.01; hazard ratio, 4.84). Overall survival was significantly better in the CRS < 0.2 group than in the CRS > 0.2 group (p < 0.01).
  
  
  CONCLUSIONS
  The E-PASS score system was a useful predictor of postoperative complications and mortality, especially in patients with advanced age.
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Tominaga
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeshita
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Takagi
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Kunizaki
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: To
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.|Division of Surgical Oncology and Regulation of Organ Function, Miyazaki University Graduate School of Medicine, Miyazaki, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
authors.affiliation: Department of Health Science, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan. sawai@nagasaki-u.ac.jp.|Division of Surgical Oncology, Department of Health Science, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. sawai@nagasaki-u.ac.jp.
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000401:mortality; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D062072:Patient Acuity; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013312:Stress, Physiological; D015996:Survival Rate
keywords: Colorectal cancer; Elderly patient; Estimation of physiologic ability and surgical stress (E-PASS); Surgery