Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Emergency Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Ann Palliat Med. 2021 Aug;10(8):8672-8683. doi: 10.21037/apm-21-941. Epub 2021 Aug 12.
Conflicting results exist about the usefulness of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) model in patients undergoing digestive surgeries. Thus, this study aims to analyze and evaluate the E-PASS model for predicting postoperative complications and mortality.
A literature search strategy for "E-PASS" was carried out in PubMed, Embase, Google Scholar, 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.
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).
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.
关于生理能力和手术应激估计（E-PASS）模型在接受消化系统手术的患者中的有用性，存在相互矛盾的结果。因此，本研究旨在分析和评估 E-PASS 模型预测术后并发症和死亡率的能力。
在 PubMed、Embase、Google Scholar、Ovid 和 Cochrane 数据库中，对截止到 2020 年 11 月发表的关于“E-PASS”的文献进行检索策略。在所有数据库中均使用“E-PASS”或“生理能力和手术应激估计”作为检索词，共选择了 20 项发表的、有与消化系统手术相关的可用数据的英文研究。收集临床数据和指标，包括术前风险评分（PRS）、手术应激评分（SSS）、综合风险评分（CRS）、术后并发症、死亡率和总生存率（OS）。使用 Review Manager 版本 5.3 和 STATA 14.0 进行异质性的荟萃分析。
本荟萃分析纳入了 20 项研究，共 9136 例患者。使用随机效应模型，术后并发症患者的 E-PASS 模型指标显著大于无并发症患者[PRS：95%置信区间（CI）：0.14-1.50；SSS：95%CI：0.28-1.06；CRS：95%CI：0.48-1.49]。此外，患者的发病率和死亡率与较高的 CRS 相关（发病率：95%CI：2.17-6.29；死亡率：95%CI：1.57-4.78），而亚组分析显示，老年人的高 CRS 与发病率增加相关（95%CI：1.57-4.78），无异质性。此外，我们发现，E-PASS CRS 较高与消化系统手术后的较短 OS 显著相关（95%CI：1.24-5.41）。
E-PASS 模型中的较高 CRS 评分伴随着许多术后并发症、死亡率增加和较短的 OS。总的来说，E-PASS 模型是一种方便有效的消化系统手术患者风险评估方法。预计将开展更严格设计的研究，以更好地评估该模型在消化系统手术中的应用价值。
