Accurate prediction of severe postoperative complications after pancreatic surgery: POSSUM vs E‐PASS

Abstract

Despite recent advances in the perioperative management of surgical patients and operative techniques, there is still a high incidence of postoperative complications (PCs) such as postoperative pancreatic fistula (POPF) after pancreatic surgery which can lead to life-threatening complications including intra-abdominal infections, severe sepsis, and massive bleeding. The most commonly used assessment tools for the prediction of PCs after gastrointestinal surgery are the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and estimation of physiologic ability and surgical stress (E-PASS). 1,2 POSSUM was developed in the United Kingdom in 1991 for surgical audit. 1 This scoring system is widely known as the first prevalent tool to predict PCs and has been used in various surgical subspecialties worldwide. On the other hand, E-PASS was developed in Japan

Estimation of Physiologic Ability and Surgical Stress scoring system for predicting complications following abdominal surgery: A meta-analysis spanning 2004 to 2022

“…The PRS, SSS and CRS values are shown from top to bottom in order (Figure 3A ). In the PRS analysis, a total of 2183 patients participated in 10 studies[ 11 , 16 , 19 - 26 ] that reported the relationship between PRS scores and postoperative complications. The mean value of PRS in the group with complications was 0.45, and that without complications was 0.40.…”

“…Since the data had significant heterogeneity ( I 2 = 87%), sensitivity analyses were performed by using a fixed-effect model and removing two low-quality studies[ 16 , 21 ]. The results showed that the SSS score in the group with complications was 0.06% higher than that in the group without complications, which was reliable for the homogeneity of the two groups [MD (95%CI): 0.06 (0.04-0.09), P < 0.0001, I 2 = 0].…”

“…Developed in the United Kingdom in 1991[ 33 ], the POSSUM system integrates 12 physiological factors and 6 surgical factors, generating Physiological score (P score) and Operative score (O score), respectively. However, both POSSUM and P-POSSUM scores that have complex calculation formulas[ 16 ] are acknowledged for their tendency to overestimate postoperative mortality in digestive surgery[ 34 , 35 ]. Additionally, the revised modified E-PASS score, while having not been extensively tested[ 36 ], shows reduced accuracy in elderly patients undergoing perihilar cholangiocarcinoma surgery[ 6 ].…”

“…Comparative analyses have consistently shown that E-PASS scores prove more convenient and effective than POSSUM scores and ASA scores, particularly in the realms of hepatobiliary, pancreatic, and gastrointestinal surgeries. Furthermore, E-PASS scores outperform other scoring models in their predictive accuracy for postoperative complications[ 16 , 23 , 25 , 28 ]. Widely recognized as a robust evaluation system, the E-PASS scoring system excels in predicting postoperative complications in abdominal surgery.…”

“…Given that the SSS score incorporates the variable of skin incisions, the consideration of laparoscopy as a factor is integral in ensuring the feasibility and appropriateness of the evaluation across the diverse studies. Postoperative complications were evaluated according to the Clavien-Dindo (CD) classification[ 15 ], which was established in 2004[ 16 ] and is a simple and feasible classification system for the severity of postoperative complications. CD categorization is a simple grading of postoperative complications used in common surgery: Grade I is a deviation from the normal postoperative course without any treatment, grade II is a need for medication, grade III is a need for surgery, endoscopic or radiological intervention, grade IV is a life-threatening condition requiring intensive care unit management, and grade V is death.…”