E-PASS (The Estimation of Physiologic Ability and Surgical Stress) Scoring System Helps the Prediction of Postoperative Morbidity and Mortality in Thoracic Surgery

Abstract

Objective: When a new scoring system, ‘E-PASS’, standing for the Estimation of Physiologic Ability and Surgical Stress that predicts the postoperative surgical risk by quantification of the patient’s reserve and surgical stress applied to a population of general thoracic surgery patients, it should be investigated if this system could help us or not. Methods: The comprehensive risk score (CRS) of the E-PASS and the clinical course were evaluated retrospectively in 282 consecutive patients with primary lung cancer (group A), and in 458 patients who underwent elective thoracic operations (group B). Results: The morbidity and mortality rates in both group A and group B increased as the CRS increased. The CRS correlated significantly with the morbidity score, length of stay and cost of hospitalization. Conclusions: E-PASS scoring system may be useful in surgical decision-making and evaluating quality of care in patients who are tolerable for lung resection.

Evaluation of modified Estimation of Physiologic Ability and Surgical Stress in gastric carcinoma surgery

“…The E-PASS scoring system was constructed on the hypothesis that overwhelming surgical stress exceeding the patient's reserve capacity can lead to the disruption of homeostasis and various kinds of postoperative morbidity. E-PASS has been reported to have a predictive value in other fields of surgery, such as orthopedic surgery [31], vascular surgery [32], and lung surgery [33]. Furthermore, our recent cohort study demonstrated that E-PASS has a high discrimination and calibration power in cardiac surgery as well (unpublished data).…”

Validation of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) Score for Maintenance Hemodialysis Patients Undergoing Elective Abdominal Surgery

“…Other studies focusing on distal pancreatectomy, pancreaticoduodenectomy, emergency surgery patients with acute gastrointestinal disease, elderly patients or other populations have shown that the E-PASS scoring system is useful to predict postoperative morbidity and mortality [15,16,17]. The E-PASS scoring system, which was developed for the spectrum of general surgical audit, has been applied to various subspecialties [9,10,11]. However, our findings suggest that surgical risk was not significantly increased in hemodialysis patients undergoing elective surgery when the mean (± standard deviation) CRS score was between 0.54 (±0.29) and 0.44 (±0.27).…”

“…Patients are categorized into 5 groups based on the E-PASS score, which allows risk stratification of expected morbidity and mortality [8]. Other authors have already validated the E-PASS score and shown its reproducibility not only for gastrointestinal surgery, but also for elective repair of abdominal aortic aneurysms, thoracic surgery and osteosynthesis for hip fractures [9,10,11]. A possible advantage of the E-PASS scoring system includes better overall assessment that not only permits evaluation of a patient's preoperative reserve capacities, but also allows a concise judgment of applied surgical stress [12].…”

New Equations for Predicting Postoperative Risk in Patients with Hip Fracture

“…When E-PASS was applied to gastrointestinal and pulmonary surgery, the comprehensive risk score (CRS) correlated with mortality and morbidity rates [6,17,31]. We reported the postoperative hospital morbidity and mortality rates increased linearly with the preoperative risk score (PRS) and CRS and they correlated in patients who had undergone osteosynthesis or arthroplasty for hip fracture [8,9].…”