Estimation of Physiologic Ability and Surgical Stress (E-PASS) Predicts Postoperative Major Complications After Hepato-Pancreato Biliary Surgery in the Elderly

Background As society ages, an increasing number of elderly patients require hepato-pancreato-biliary (HPB) surgery. We investigated the risk factors for complications in elderly patients undergoing HPB surgery using surgical risk scoring models. Methods We retrospectively investigated 184 elderly patients (>= 65 years old) who underwent HPB surgery, including the liver, pancreas, bile duct, and/or gallbladder resection, with exemption to simple cholecystectomy between January 2017 and December 2019. The surgical risk scoring models used included the Estimation of Physiological Ability and Surgical Stress (E-PASS), Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), and Geriatric 8 (G8). We evaluated the correlations between the scores and severe complications. Complications were classified as severe (Clavien-Dindo classification [C-D] >= III) or non-severe (C-D <= II). Results Complications occurred in 78 patients (24 C-D >= III, 54 C-D <= II). Preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) were significantly higher in patients with C-D >= IIIa than in those with C-D <= II. Multiple logistic regression analysis revealed that PRS (P = 0.01) and SSS (P = 0.04) were independent predictive factors for severe complications. However, the POSSUM and G8 models showed no significant correlations to severe complications. Conclusion E-PASS is a useful model for predicting complications in elderly patients undergoing HPB surgery.

Automated summary

We investigated the risk factors for complications in elderly patients undergoing hepato-pancreato-biliary surgery using surgical risk scoring models. The E-PASS model was found to be useful in predicting complications, while the POSSUM and G8 models showed no significant correlations.