Tang Tjun, Walsh Stewart R, Fanshawe Thomas R, Gillard Jonathan H, Sadat Umar, Varty Kevin, Gaunt Michael E, Boyle Jonathan R
Vascular Unit, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK.
Am J Surg. 2007 Aug;194(2):176-82. doi: 10.1016/j.amjsurg.2006.10.032.
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.
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.
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).
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.
生理能力与手术应激评估（E-PASS）评分是基于患者生理储备能力与手术中施加的手术应激之间的平衡对术后并发症的发生至关重要这一前提设计的。本研究的目的是评估其在预测择期开放性腹主动脉瘤（AAA）修复术后死亡率和发病率方面的价值。
前瞻性收集了一组在6年期间接受择期开放性AAA修复的204例患者的E-PASS数据项。将手术发病率和死亡率与E-PASS的术前风险评分（PRS）、手术应激评分（SSS）和综合风险评分（CRS）进行比较。该组包括180例（88%）男性，中位年龄为73岁（范围44至86岁）。
有13例（6%）死亡，121例（59%）发生术后并发症。随着PRS、SSS和CRS升高，术后发病率和死亡率显著增加（P <.0001）。总体平均CRS为0.52（±0.27）。存活和死亡患者组的平均CRS分别为0.49（±0.24）和0.98（±0.26）。PRS、SSS和CRS对死亡率和发病率均具有极好的预测能力，受试者工作特征曲线下面积较高（范围0.799至0.953）即证明了这一点。CRS还与术后并发症的严重程度（P <.0001）和住院时间（P <.0001）显示出强烈的统计学显著关联。
E-PASS模型似乎是预测择期开放性AAA手术患者死亡和术后并发症发生的一种有前景的方法。它需要在不同地理位置的动脉手术中进一步验证。
