生理能力与手术应激评分系统预测食管癌术后并发症临床研究

目的探讨生理能力与手术应激评分系统(E-PASS)预测食管癌择期手术风险和术后早期并发症的临床应用价值。方法食管癌择期手术患者206例,比较有并发症组和无并发症组预测指标的差异,并确定综合风险分数(CRS)预警术后并发症的切点值。结果 206例患者中,术后并发症发生率为54.3%。并发症阳性组的术前生理学分数(PRS)、手术应激分数(SSS)及综合风险分数(CRS)均高于并发症阴性组,两组比较差异有统计学意义(P0.05)。PRS、SSS及CRS的ROC曲线下面积分别为0.63、0.74和0.76。CRS预警术后并发症的切点值为0.40。结论E-PASS量表可较为准确的预测食管癌术后并发症的发生。     

生理能力与手术应激评分系统预测食管癌后并发症临床研究

目的 探讨生理能力与手术应激评分系统(E-PASS)预测食管癌择期手术风险和术后早期并发症的临床应用价值.方法 食管癌择期手术患者206例,比较有并发症组和无并发症组预测指标的差异,并确定综合风险分数(CRS)预警术后并发症的切点值.结果 206例患者中,术后并发症发生率为54.3％.并发症阳性组的术前生理学分数(PRS)、手术应激分数(sss)及综合风险分数(CRS)均高于并发症阴性组,两组比较差异有统计学意义(P＜0.05).PRS、SSS及CRS的ROC曲线下面积分别为0.63、0.74和0.76.CRS预警术后并发症的切点值为0.40.结论 E-PASS量表可较为准确的预测食管癌术后并发症的发生.     

E-PASS系统评估结直肠癌手术风险的临床价值

目的采用生理能力与手术侵袭度评分系统(E-PASS)预测结直肠癌患者择期手术风险,探讨其在术后并发症风险预测中的临床应用价值。方法回顾性分析313例结直肠癌患者使用E-PASS评分系统评估其手术风险,比较E-PASS中的术前风险分数(PRS)、手术侵袭度分数(SSS)和综合风险分数(CRS)评分与实际手术预后的关系,并探讨E-PASS各项指标与术后风险的关系。结果纳入分析的患者中,有22例(7.0%)患者发生术后并发症。患者的年龄(P=0.003)、体重(P=0.019)、肿瘤组织学类型(P=0.033)、Dukes分期(P=0.001)、严重心脏疾病(P=0.019)、严重肺部疾病(P=0.000)、体能状态指数(P=0.000)、失血量/体重(P=0.007)、失血量(P=0.001)和手术时间(P=0.000)均与并发症的发生相关;肿瘤分化程度(P=0.503)、糖尿病(P=0.745)、ASA分级(P=0.085)和手术切口大小(P=0.726)与并发症的发生无关。有并发症组的PRS和CRS明显高于无并发症组(P<0.001),而SSS在2组间的差异无统计学意义(P=0.059)。结论 E-PASS评分系统是一个相对方便、有效和易操作的手术风险评估系统,能够较准确地预测结直肠癌患者术后短期并发症的发生。     

生理能力与手术侵袭度评分系统评估结肠癌手术风险的临床价值

目的 探讨生理能力与手术侵袭度(E-PASS)评分系统预测结肠癌患者择期手术后并发症风险的临床应用价值.方法 回顾性分析2009年8月至10月四川大学华西医院收治的符合本研究纳入标准的158例结肠癌患者的临床资料.采用E-PASS评分系统评估其手术风险,并比较E-PASS评分系统中的术前风险分数(PRS)、手术侵袭度分数(SSS)和综合风险分数(CRS)评分与实际手术预后的关系.采用多元线性回归分析E-PASS评分系统各项指标与术后风险的关系.结果 纳入分析的158例患者中,经过E-PASS评分系统预评估的术后近期并发症总体发生率为19.4%±2.0%,术后实际并发症发生率为17.1%(27/158).并发症的发生与Dukes分期、体能状态指数分级、严重心脏疾病、严重肺部疾病、手术时间有关(r=0.193,0.410,0.183,0.174,0.198,P＜0.05);且PRS、CRS和SSS均具有良好的预测作用(r=0.299,0.349,0.183,P＜0.05).结论 E-PASS评分系统是一个相对方便有效,易操作的手术风险评估系统,能够准确预测结肠癌患者的术后早期并发症发生风险.     

生理功能和手术应激评分系统评估髋部骨折手术风险的临床价值

目的采用生理能力与手术应激评分系统(E-PASS)预测老年髋部骨折患者手术风险并探讨其应用价值。方法前瞻性选择267例年龄大于65岁的髋部骨折手术患者,病理性骨折及6个月内有其他手术史的患者除外,按照E-PASS评分系统评估其手术风险,选用2检验和非配对t检验评估其预测术后并发症及死亡的有效性,采用Spearman等级相关分析评价术前风险分数(PRS)、手术应激分数(SSS)和综合风险分数(CRS)与预后的相关性。结果 E-PASS评分系统预测住院期间并发症75例(28.1%),实际发生并发症71例(26.6%),组间差异无统计学意义(2=2.562,P0.05),观察值与预测值比值(O/E)为0.94;预测住院期间死亡12例(7.2%),实际死亡8例(3.9%),组间差异无统计学意义(2=1.773,P0.05),O/E为0.67;并发症组及死亡组患者PRS(t=18.7,P0.01;t=8.489,P0.01)及CRS(t=18.45,P0.01;t=19.83,P0.01),明显高于无并发症组及非死亡组,而SSS则无明显差异(P0.05);PRS和CRS与术后并发症率(rs=0.18,P0.01;rs=0.15,P0.01)和死亡率(rs=0.16,P0.01,rs=0.17,P0.01)具有明显相关性。结论E-PASS评分系统使用方便,操作简单,能够较准确、有效地评估老年髋部骨折术后住院期间并发症和死亡。     

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目的探讨生理能力与手术应激评分系统(E-PASS)预测胃肿瘤择期手术风险和术后早期并发症的临床应用价值。方法前瞻性收集2011年11月至2012年2月四川大学华西医院胃肠外科中心121例胃肿瘤择期手术病人的临床资料,比较有并发症组和无并发症组的临床-手术-病理相关指标有无差异,并确定综合风险分数(CRS)预警术后并发症的切点值。结果 121例病人中术后并发症发生率为14.9%,有并发症组和无并发症组的年龄、性别、肿瘤组织学类型、糖尿病、体能状态指数、美国麻醉医师协会(ASA)分级、切口大小、失血量-体重比、体重、失血量、手术时间、术前风险分数(PRS)和手术应激分数(SSS)的差异无统计学意义;而两组之间术前合并严重心脏疾病(P=0.000)和严重肺部疾病(P=0.000)差异有统计学意义。有并发症组CRS高于无并发症组(P=0.043),但相关分析并未得出CRS值预警术后并发症的切点值(r<0.400,P>0.05)。结论 E-PASS评分系统中CRS值对预测胃肿瘤择期手术风险有一定价值,但CRS预警切点值的确定须进一步研究。     

E—PASS系统预测直肠癌术后近期并发症风险

目的采用E—PASS评分系统预测结直肠癌患者择期手术风险,探讨其对术后并发症风险预测的意义。方法回顾性分析2009年9月至2010年5月期间符合纳人标准的直肠癌患者,使用E—PASS评分系统评估其手术风险,并比较E—PASS中的PRS、SSS和CRS评分与实际手术预后的关系。并探讨E—PASS各项指标与术后风险的关系。结果纳入分析的155例患者中,32例（20．5％）患者发生术后并发症。研究发现PRS（P〈0．001）和CRS（P〈0．001）能较好地预测术后并发症,而SSS（P＝0．901）在两组的差异无统计学意义;在并发症组与无并发症组中,年龄（P〈0．001）、严重肺部疾病（P〈0．001）、体能状态指数（P〈0．001）、手术切口程度（P=0．014）、失血量／体重（P=0．046）和手术时间（P〈0．001）与并发症的发生相关,差异有统计学意义。结论E—PASS评分系统是一个相对方便有效,易操作的手术风险评估系统,能够预测直肠癌患者的术后短期并发症发生率。     

E-PASS评分系统预测胃肿瘤术后并发症临床价值研究

目的 探讨生理能力与手术应激评分系统（E-PASS）预测胃肿瘤择期手术风险和术后早期并发症的临床应用价值。方法 前瞻性收集2011年11月至2012年2月四川大学华西医院胃肠外科中心121例胃肿瘤择期手术病人的临床资料,比较有并发症组和无并发症组的临床-手术-病理相关指标有无差异,并确定综合风险分数（CRS ）预警术后并发症的切点值。 结果 121例病人中术后并发症发生率为14.9%,有并发症组和无并发症组的年龄、性别、肿瘤组织学类型、糖尿病、体能状态指数、美国麻醉医师协会（ASA）分级、切口大小、失血量-体重比、体重、失血量、手术时间、术前风险分数（PRS）和手术应激分数（SSS）的差异无统计学意义;而两组之间术前合并严重心脏疾病（P=0.000）和严重肺部疾病（P=0.000）差异有统计学意义。有并发症组CRS高于无并发症组（P=0.043）,但相关分析并未得出CRS值预警术后并发症的切点值（r＜0.400,P＞0.05）。结论 E-PASS评分系统中CRS值对预测胃肿瘤择期手术风险有一定价值,但CRS预警切点值的确定须进一步研究。     

临床危险评分系统对结直肠癌肝转移患者生存预测及指导新辅助化疗的意义研究

目的评估临床危险评分系统(CRS)对我国结直肠癌肝转移患者的生存预测及指导新辅助化疗决策的作用。方法回顾性分析2000年1月至2012年12月在中山大学肿瘤医院行手术治疗的145例结直肠癌肝转移患者的临床资料,并随访其复发和生存情况,比较CRS低危组和高危组患者的预后差异并分析CRS评分对患者新辅助化疗的影响。结果低危组和高危组患者的中位总生存时间分别为47.5(32,75)个月和21(12,38)个月,差异有统计学意义(P 0.05);低危组和高危组患者的无复发中位生存时间分别为32(9,67)个月和11(7,18)个月,差异有统计学意义(P 0.05)。低危组中接受新辅助化疗和直接手术患者的中位总生存时间分别为42(26,64)个月和55(32,78)个月,差异无统计学意义(P 0.05);无复发中位生存时间分别为11(7,56)个月和45(13,73)个月,差异有统计学意义(P 0.05)。高危组中接受新辅助化疗和直接手术患者的中位总生存时间分别为33.5(12,48)个月和17(13,26)个月,差异无统计学意义(P 0.05);无复发中位生存时间分别为10(6,22)个月和12(7,16)个月,差异无统计学意义(P 0.05)。结论 CRS对结直肠癌肝转移患者的生存情况有较好的预测作用,但是否能作为此类患者实施新辅助化疗的参考依据还需要进一步的研究。     

多学科协作诊治模式下新辅助/辅助化疗联合结直肠癌手术的临床效果

目的 探讨多学科协作(multi-disciplinary team, MDT)诊治模式下,结直肠癌手术围手术期不同新辅助/辅助化疗治疗策略的临床效果.方法 回顾性分析2007年1～12月期间四川大学华西医院肛肠外科专业组收治确诊为结直肠癌患者的临床资料,将患者分为非辅助化疗组(新辅助化疗 手术治疗)和辅助化疗组(新辅助化疗 手术治疗 辅助化疗),比较2组的治疗效果.结果 共收治了789例结直肠疾病患者,其中明确诊断为结直肠癌并符合纳入研究条件的患者195例,其中男109例,女86例; 年龄为25～84岁,中位年龄60.00岁,平均59.98岁; 结肠癌59例,直肠癌136例.随访时间为5～17个月,全部195例患者中失访3例,成功随访率为98.5%,随访期间无复发和死亡.2组患者基线基本一致,2组间术前内科合并症、肿瘤并发梗阻症状和术前是否输血的差异无统计学意义(P＞0.05); 2组在术中是否输血和Dukes分期方面的差异有统计学意义(P＜0.05),而其他手术相关指标和病理指标间差异无统计学意义(P＞0.05); 在术后治疗中,2组间是否输血的差异有统计学意义(P＜0.05); 术后住院期间康复指标在2组间差异无统计学意义(P＞0.05); 2组间术后并发症和排便情况差异无统计学意义(P＞0.05).术后1和3个月随访中发现,2组间CEA和CA19-9值差异有统计学意义(P＜0.05).结论 在MDT诊治模式下,进行新辅助化疗 手术治疗 辅助化疗方案并不影响患者的康复,也不增加患者术后并发症的风险,并可能提高患者术后对排便习惯的接受程度,具有一定的安全性和临床价值,但是否能提高临床效果有待进一步研究.     

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

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.     

Usefulness of an Estimation of Physiologic Ability and Surgical Stress (E-PASS) Scoring System to Predict the Incidence of Postoperative Complications in Gastrointestinal Surgery

Surgical intervention induces various host responses to maintain homeostasis. When postoperative inflammation is intense and persists for a long time, postoperative complications may occur, sometimes developing into multiple organ failure. Therefore, it is very important to assess surgical stress and predict the risk of morbidity and mortality. Using a new scoring system, an estimation of physiologic ability and surgical stress (E-PASS) scoring system, surgical stress following gastrointestinal surgery was evaluated to assess the feasibility of this scoring system. This system comprises a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS) that is calculated from both the PRS and the SSS. The relationship of the E-PASS score to the incidence of morbidity and mortality was examined. The relationship between the E-PASS score and a sequential organ failure (SOFA) score was also evaluated. The CRS had a significant positive correlation between not only the incidence but also the grade of postoperative complications. Total maximum SOFA score in patients with a CRS of more than 1 was significantly higher than that in patients with a CRS of less than 1. In conclusion, the E-PASS scoring system will be useful for predicting and recognizing the risk of postoperative complications. This scoring system is brief, simple, and reproducible and can be useful in all types of hospitals.     

Evaluation of estimation of physiologic ability and surgical stress (E-PASS) to predict the postoperative risk for hip fracture in elder patients

Introduction  The Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system is comprised of a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS) determined by both the PRS and SSS. E-PASS predicts the postoperative risk by quantifying the patient’s reserve and surgical stress in general surgery. This study aims to evaluate the usefulness of this scoring system for the hospitalization outcomes in hip fracture. Patients and methods  A consecutive series of 419 elderly patients who underwent surgery with osteosynthesis or arthroplasty for hip fracture were prospectively assessed for the E-PASS scoring system, which was compared with their postoperative course. Results  The postoperative morbidity and mortality rates in hospital increased linearly as the PRS and CRS increased, with significant correlation (ρ = 0.2, P < 0.01) in both operations. The cost of hospital stay also related significantly to the SSS (r = 0.6, P < 0.0001) and CRS (r = 0.4, P < 0.0001). Conclusion  These results suggest that E-PASS may be useful for predicting postoperative risk and estimating medical expense for surgical cases with hip fracture.     

Comparison of surgical outcome using the prediction scoring system of E-PASS for thoracic surgery.

OBJECTIVE: The purpose of this study was to determine if our predictive scoring system, E-PASS, can estimate the surgical outcome. METHODS: We conducted a multicenter cohort study for 3 years in four national hospitals. A consecutive series of 731 patients who underwent elective thoracic operations were analyzed. The preoperative risk score (PRS) and the comprehensive risk score (CRS) of the E-PASS were determined preoperatively and immediately after the operation, respectively. The cost of the surgical admission and the severity of the postoperative complications were recorded at the time of discharge. RESULTS: The CRS significantly correlated with the severity of the postoperative complications (rs = 0.728, P < 0.0001) and the charge (rs = 0.530, P< 0.0001). When the estimated/real morbidity ratio (MR) among the hospitals was compared, it varied from 0.16 to 0.59. A significant increase in the cost was observed according to the CRS. CONCLUSION: The E-PASS scoring system may be useful for standardizing the patient population and surgical severity to compare the surgical outcome.     

Feasibility of E-PASS score to predict postoperative complications in laparoscopic nephrectomy

Purpose

To evaluate the usefulness of E-PASS score to predict postoperative complications after laparoscopic nephrectomy.

Methods

Between 2008 and 2020, 424 patients (179 patients: simple nephrectomy, 158 patients: radical nephrectomy, 87 patients: donor nephrectomy) who underwent laparoscopic nephrectomy in our clinic, were included in the study. Patient groups separated according to the presence of postoperative complications were compared retrospectively regarding demographic, clinical, intraoperative, and postoperative data, comorbidities, and E-PASS scores (PRS, SSS, and CRS). The relationship between postoperative complications and E-PASS scores was examined.

Results

Postoperative complications occurred in 43 (10.1%) of the patients. Age, previous abdominal/retroperitoneal surgery, radical nephrectomy rate of surgeries, operation time, amount of bleeding, need for blood transfusion, rate of conversion from laparoscopic surgery to open surgery, hospitalization time, E-PASS PRS, SSS, and CRS were statistically significantly higher in the group with postoperative complications. The cutoff value of the E-PASS CRS was ? 0.2996 to predict the development of postoperative complications (AUC?=?0.706; 95% CI 0.629–0.783; p?<?0.001). According to multivariate analysis, presence of previous abdominal/retroperitoneal surgery (OR?2.977; 95% CI?1.502–5.899; p?=?0.002), laparoscopic radical nephrectomy (OR?2.518; 95% CI?1.224–5.179; p?=?0.012), conversion from laparoscopic surgery to open surgery (OR?4.869; 95% CI?1.046–22.669; p?=?0.044) and E-PASS CRS?>?? 0.2996 (OR?2.816; 95% CI?1.321–6.004; p?=?0.007) were found to be independent risk factors predicting postoperative complications.

Conclusion

The E-PASS scoring system is an effective and convenient system for predicting postoperative complications after laparoscopic nephrectomy.