Banz Vanessa M, Studer Peter, Inderbitzin Daniel, Candinas Daniel
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital and University of Bern, CH-3010, Bern, Switzerland.
World J Surg. 2009 Jun;33(6):1259-65. doi: 10.1007/s00268-009-9989-2.
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).
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.
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.
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.
生理能力与手术应激评估（E-PASS）已被用于对择期胃肠手术后的预期死亡率和发病率进行数值估计。本研究的目的是在一组需要肝切除术（LR）的特定患者队列中验证E-PASS。
在这项回顾性研究中，将E-PASS发病率和死亡率预测方程应用于243例需要肝切除术患者的前瞻性数据。使用Fisher精确检验将观察到的发生率与预测发生率进行比较。使用受试者工作特征（ROC）曲线分析评估E-PASS的判别能力。
观察到的和预测的总死亡率均为3.3%，发病率分别为31.3%和26.9%。死亡患者和存活患者的综合风险评分存在显著差异（p = 0.043）。然而，有并发症和无并发症患者的评分无显著差异（p = 0.120）。随后的ROC曲线分析显示发病率的预测准确性较差。
E-PASS评分似乎能有效预测这一特定患者群体的死亡率，但对并发症的预测能力较差。可能需要一种新的改良逻辑回归方法来更好地预测肝切除术患者的术后结局。
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