Open AccessValidation of the Estimation of Physiologic Ability and Surgical Stress (E‐PASS) Score in Liver Surgery
Author(s) -
Banz Vanessa M.,
Studer Peter,
Inderbitzin Daniel,
Candinas Daniel
Publication year - 2009
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-009-9989-2
Subject(s) - medicine , receiver operating characteristic , logistic regression , abdominal surgery , vascular surgery , retrospective cohort study , surgery , cardiac surgery , mortality rate , cardiothoracic surgery , prospective cohort study
Background The estimation of physiologic ability and surgical stress (E‐PASS) has been used to produce a numerical estimate of expected mortality and morbidity after elective gastrointestinal surgery. The aim of this study was to validate E‐PASS in a selected cohort of patients requiring liver resections (LR). Methods In this retrospective study, E‐PASS predictor equations for morbidity and mortality were applied to the prospective data from 243 patients requiring LR. The observed rates were compared with predicted rates using Fisher’s exact test. The discriminative capability of E‐PASS was evaluated using receiver‐operating characteristic (ROC) curve analysis. Results The observed and predicted overall mortality rates were both 3.3% and the morbidity rates were 31.3 and 26.9%, respectively. There was a significant difference in the comprehensive risk scores for deceased and surviving patients ( p = 0.043). However, the scores for patients with or without complications were not significantly different ( p = 0.120). Subsequent ROC curve analysis revealed a poor predictive accuracy for morbidity. Conclusions The E‐PASS score seems to effectively predict mortality in this specific group of patients but is a poor predictor of complications. A new modified logistic regression might be required for LR in order to better predict the postoperative outcome.