INTERNATIONAL JOURNAL OF COLORECTAL DISEASE 31, 2, 217 - 225 (2016).
E-PASS score as a useful predictor of postoperative complications and mortality after colorectal surgery in elderly patients
Tetsuro Tominaga , Hiroaki Takeshita , Katsunori Takagi , Masaki Kunizaki , Kazuo To , Takafumi Abo , Shigekazu Hidaka , Atsushi Nanashima , Takeshi Nagayasu , Terumitsu Sawai
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. 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. 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 a parts per thousand yenaEuro parts per thousand 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). The E-PASS score system was a useful predictor of postoperative complications and mortality, especially in patients with advanced age.