Value of E-PASS models for predicting postoperative morbidity and mortality in resection of perihilar cholangiocarcinoma and gallbladder carcinoma

Haga, Yoshio; Miyamoto, Atsushi; Wada, Yasuo; Takami, Yuko; Takeuchi, Hitoshi

doi:10.1016/j.hpb.2015.09.001

Cited by 14 publications

(27 citation statements)

References 24 publications

(42 reference statements)

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“…Estimation of physiologic ability and surgical stress (E-PASS) system is a more recent predicting system developed by Haga et al [ 10 ] According to his following examination studies, E-PASS was reported to have a good death predicting ability in various surgeries including colorectal cancer surgery. [ 11 – 13 ]…”

Section: Introductionmentioning

confidence: 99%

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

Zhang

Liu²,

Zheng³

et al. 2017

Medicine

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Laparoscopic colorectal surgery had been widely used for colorectal cancer patient and showed a favorable outcome on the postoperative morbidity rate. We attempted to evaluate physiological status of patients by mean of Estimation of physiologic ability and surgical stress (E-PASS) system and to analyze the difference variation of postoperative morbidity rate of open and laparoscopic colorectal cancer surgery in patients with different physiological status.In total 550 colorectal cancer patients who underwent surgery treatment were included. E-PASS and some conventional scoring systems were reviewed to examine their mortality prediction ability. The preoperative risk score (PRS) in the E-PASS system was used to evaluate the physiological status of patients. The difference of postoperative morbidity rate between open and laparoscopic colorectal cancer surgeries was analyzed respectively in patients with different physiological status.E-PASS had better prediction ability than other conventional scoring systems in colorectal cancer surgeries. Postoperative morbidities were developed in 143 patients. The parameters in the E-PASS system had positive correlations with postoperative morbidity. The overall postoperative morbidity rate of laparoscopic surgeries was lower than open surgeries (19.61% and 28.46%), but the postoperative morbidity rate of laparoscopic surgeries increased more significantly than in open surgery as PRS increased. When PRS was more than 0.7, the postoperative morbidity rate of laparoscopic surgeries would exceed the postoperative morbidity rate of open surgeries.The E-PASS system was capable to evaluate the physiological and surgical risk of colorectal cancer surgery. PRS could assist preoperative decision-making on the surgical method. Colorectal cancer patients who were assessed with a low physiological risk by PRS would be safe to undergo laparoscopic surgery. On the contrary, surgeons should make decisions prudently on the operation method for patient with a high physiological risk.

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Section: Introductionmentioning

confidence: 99%

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

Zhang

Liu²,

Zheng³

et al. 2017

Medicine

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“…We also used the number of postoperative days until CRP levels decreased to < 1.0 mg/L in order to investigate the improvement outcomes of patients, and the results obtained indicated that a relationship exists between PRS scores and outcomes. Regarding the accuracy of predicting postoperative complications, previous studies demonstrated that E-PASS accurately predicted postoperative mortality in the surgical treatment of hilar cholangiocarcinoma; the AUC to detect in-hospital mortality was 0.842 for E-PASS [ 16 ]. Similar results were obtained in our study; we yielded an AUC value for the CRS to predict postoperative complications that was greater than 0.814 and calculated a cut-off value of 1.01, which was consistent with previous findings [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the accuracy of predicting postoperative complications, previous studies demonstrated that E-PASS accurately predicted postoperative mortality in the surgical treatment of hilar cholangiocarcinoma; the AUC to detect in-hospital mortality was 0.842 for E-PASS [ 16 ]. Similar results were obtained in our study; we yielded an AUC value for the CRS to predict postoperative complications that was greater than 0.814 and calculated a cut-off value of 1.01, which was consistent with previous findings [ 16 , 17 ]. Collectively, the results of the present study and previous findings support E-PASS models, particularly the CRS having a high predictive power in the field of oral and maxillofacial surgery.…”

Section: Discussionmentioning

confidence: 99%

Assessment of postoperative complications using E-PASS and APACHE II in patients undergoing oral and maxillofacial surgery

et al. 2018

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BackgroundThe prediction of postoperative complications is important for oral and maxillofacial surgeons. We herein aimed to evaluate the efficacy of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) and Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II scoring systems to predict postoperative complications in patients undergoing oral and maxillofacial surgery.MethodsThirty patients (22 males, 8 females; mean age: 65.1 ± 12.9 years) who underwent major oral surgeries and stayed in the intensive care unit for postoperative management were enrolled in this study. Postoperative complications were discriminated according to the necessity of the therapeutic intervention by the Medical Department, i.e. according to the Clavien–Dingo classification. E-PASS and APACHE II scores as well as laboratory test values were compared between patients with/without postoperative complications.ResultsPostoperative complications were developed in seven patients. The comprehensive risk score (CRS: 1.13 ± 0.24) and APACHE II score (13.0 ± 2.58) were significantly higher in patients with postoperative complications than in those without ones (p < 0.01, p < 0.05, respectively). The CRS showed an appropriate discriminatory power for predicting postoperative complications (area under the curve: 0.814). Furthermore, a correlation was detected between APACHE II scores and postoperative data until C-reactive protein levels decreased to < 1.0 mg/L (r = 0.43, p < 0.05).ConclusionThe E-PASS and APACHE II scoring systems were both shown to be useful to predict postoperative complications after oral and maxillofacial surgery.

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“…The inclusion criteria were as follows: study type (all casecontrol studies); participants (patients who underwent digestive surgery); comparison (any study that compared the E-PASS model between the patients with complications and without complications, or any study that compared the incidence of morbidity and mortality between a high E-PASS CRS group and a low E-PASS CRS group); outcomes (any form of results we were interested in, such as postoperative complications, morbidity, mortality, and overall survival). The postoperative complications expressly referred to any levels of complications classified as Clavien-Dindo, because some studies had unspecified descriptions, while some studies had Clavien-Dindo II/III/IV/V complications (8)(9)(10)(11)(12)(13)(14)(15)(16)(17).…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

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

Chen¹,

Chen²,

Dai³

et al. 2021

Ann Palliat Med

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Ovid, and Cochrane databases for studies published before November 2020. "E-PASS" or "Estimation of Physiologic Ability and Surgical Stress" were used as the search terms in all databases, and a total of 20 published English language studies with available data relating to digestive surgery were selected for this study.Clinical data and indices including preoperative risk score (PRS), surgical stress score (SSS), comprehensive risk score (CRS), postoperative complications, mortality, and overall survival (OS) were collected. Meta-analyses of heterogeneity were performed using Review Manager version 5.3 and STATA 14.0.Results: Twenty studies with 9,136 patients were included in our meta-analysis. Using a random-effects model, the indices of the E-PASS model in patients with postoperative complications were significantly greater than those in patients without complications [PRS: 95% confidence interval (CI): 0.14-1.50; SSS: 95% CI: 0.28-1.06; CRS: 95% CI: 048-1.49]. Moreover, patient morbidity and mortality were associated with a higher CRS (morbidity: 95% CI: 2.17-6.29; mortality: 95% CI: 1.57-4.78), while subgroup analyses showed that a high CRS in the elderly was related to increased morbidity (95% CI: 1.57-4.78) without heterogeneity. In addition, we found that a high E-PASS CRS was significantly associated with shorter OS after digestive surgery (95% CI: 1.24-5.41).Discussion: The higher CRS score in the E-PASS model accompanies with many postoperative complications, increased mortality and shorter OS. Collectively, the E-PASS model is a convenient and effective risk assessment for patients undergoing digestive surgeries. More stringently designed studies are expected to develop better estimates of the application value of this model in digestive surgeries.

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Value of E-PASS models for predicting postoperative morbidity and mortality in resection of perihilar cholangiocarcinoma and gallbladder carcinoma

Abstract: The E-PASS models examined herein may accurately predict postoperative morbidity and mortality in proximal biliary carcinoma resection. These models will be useful for surgical decision-making, informed consent, and risk adjustments in surgical audits.

Cited by 14 publications

References 24 publications

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk

Assessment of postoperative complications using E-PASS and APACHE II in patients undergoing oral and maxillofacial surgery

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

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