Estimation of physiologic ability and surgical stress (E-PASS) as a predictor of immediate outcome after elective abdominal aortic aneurysm surgery

Tang, Tjun; Walsh, Stewart R.; Fanshawe, Thomas R.; Gillard, Jonathan H.; Sadat, Umar; Varty, Kevin; Gaunt, Michael E.; Boyle, Jonathan R.

doi:10.1016/j.amjsurg.2006.10.032

« Previous Next »The American Journal of Surgery
Volume 194, Issue 2 , Pages 176-182, August 2007

Estimation of physiologic ability and surgical stress (E-PASS) as a predictor of immediate outcome after elective abdominal aortic aneurysm surgery

Tjun Tang, M.R.C.S.
- Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
- University Department of Radiology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Stewart R. Walsh, M.Sc.
- Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Thomas R. Fanshawe, M.A.
- Centre for Applied Medical Statistics, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
Jonathan H. Gillard, M.D.
- University Department of Radiology, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Umar Sadat, M.B.B.S.
- Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Kevin Varty, M.D.
- Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Michael E. Gaunt, M.D.
- Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
Jonathan R. Boyle, M.D.
- Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
- Corresponding author. Regional Vascular Unit, Box 201, Level 7, Cambridge University Hospital NHS Foundation Trust, Hills Road, Cambridge CB2 2QQ, United Kingdom. Tel.: +0044 1223 217246; fax: +0044 1223 216015.

Received 31 July 2006; received in revised form 23 October 2006

Abstract

Background

The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score was designed on the premise that the balance between the patient’s physiologic reserve capacity and the surgical stress inflicted at operation was important in the occurrence of postoperative complications. The aim of this study was to assess its value in predicting mortality and morbidity after open elective abdominal aortic aneurysm (AAA) repair.

Methods

E-PASS data items were collected prospectively in a group of 204 patients undergoing elective open AAA repair over a 6-year period. The operative morbidity and mortality rates were compared with the preoperative risk score (PRS), surgical stress score (SSS) and comprehensive risk score (CRS) of E-PASS. The group comprised 180 (88%) males and the median age was 73 (range 44 to 86) years.

Results

There were 13 (6%) deaths and 121 (59%) experienced a postoperative complication. As the PRS, SSS and CRS increased, the incidence of postoperative morbidity and mortality significantly increased (P < .0001). Overall mean CRS was .52 (±.27). Mean CRS in the groups of patients who survived and died were .49 (±.24) and .98 (±26), respectively. PRS, SSS, and CRS all had extremely good predictive power for both mortality and morbidity as demonstrated by high areas under the receiver operator curve (range .799 to .953). CRS also showed a strong statistically significant association with the severity of postoperative complication (P < .0001) and length of hospital stay (P < .0001).

Conclusions

The E-PASS model appears to be a promising method of predicting death and the development of postoperative complications in patients undergoing elective open AAA surgery. It requires further validation in arterial surgery at different geographical locations.

Keywords: Surgical audit, Complications, Aneurysm (abdominal aortic), Outcome, E-PASS