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

Abstract

Aims: This study assessed the validity of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) score in maintenance hemodialysis patients undergoing elective abdominal surgery. Methods: We retrospectively reviewed the medical records of 73 hemodialysis patients who underwent elective gastrointestinal surgery. The main outcomes analyzed were the E-PASS score and postoperative course, which were defined by mortality and morbidity. The discriminative capability of the E-PASS score was evaluated using receiver operating characteristic (ROC) curve analysis. Results: The overall mortality rate observed was 2.7% (2 patients) and the morbidity rate was 36.9%. There were no significant differences in the comprehensive risk score, preoperative score or surgical stress score for patients with or without complications (p = 0.556, 0.639 and 0.168, respectively). Subsequent ROC curve analysis demonstrated poor predictive accuracy for morbidity. When the results in our study population were compared with those in Haga's study population, our population exhibited a highly significant rightward shift (p < 0.001). Conclusion: The E-PASS score was a poor predictor of complications because maintenance hemodialysis patients already have relatively high risk factors. This scoring system should not be applied in such a special group with high risk factors. i 2014 S. Karger AG, Basel

Review of risk assessment tools to predict morbidity and mortality in elderly surgical patients

“…The E-PASS score was developed in gastrointestinal surgical patients 63 and subsequently validated for complications in elderly colorectal surgery patients, 64 liver surgery 65 and hip fracture 66 patient groups however it should not be used in hemodialysis patients. 67 The E-PASS AUC was 0.78 for the overall model, better than for the colorectal-POSSUM and Prognostic Nutrition Index in elderly colorectal surgery patients. 64 A Comprehensive Risk Score (CRS) !…”

The Estimation of Physiologic Ability and Surgical Stress (E-PASS) model as a predictor of postoperative complications and mortality after digestive surgeries: a meta-analysis and systematic review

“…The AUC values of the included studies varied from each other, with 6 studies reporting that the E-PASS model did not accurately predict morbidity, showing AUC values <0.7 (14,16,17,(19)(20)(21). Furthermore, the E-PASS model lost its accuracy in the western population, as demonstrated by the 3 studies from western countries in our pooled analyses which reported low AUC values (17,20,21).…”

“…In the analysis of PRS, a total of 1,076 patients were enrolled in the six studies (11,15,(19)(20)(21)(22). After conducting pooled analysis using a random-effects model (I 2 =96%, P<0.001, Figure 2A; I 2 =97%, P<0.001, Figure S1), we found that the PRS in patients with postoperative complications was significantly greater than it in the patients without complications (SMD =0.82, 95% CI: 0.14-1.50, P=0.020, Figure 2A; SMD =1.77, 95% CI: 0.26-3.27, P=0.020, Figure S1).…”

“…Included were 8 studies with 1,197 patients that explored the differences in the CRS (11,12,15,(19)(20)(21)(22)(23). High heterogeneity was found across all studies, with a random-effects model being applied (I 2 =93%, P<0.001, Figure 2C).…”

“…We further compared the morbidity in the 2 CRS groups, analyzing 15 studies that included 2,266 digestive surgery patients (1,9,10,(13)(14)(15)(16)(17)(19)(20)(21)(22)(23)(24)(25). With regard to heterogeneity (I 2 =81%, P<0.001, Figure 3A), the pooled data demonstrated that patients with a high CRS were expected to have higher chance of morbidity (OR =3.69, 95% CI: 2.17-6.29, P<0.001, Figure 3A).…”