Feasibility of a Modified E-PASS and POSSUM system for Postoperative Risk Assessment in Patients with Spinal Disease.

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Feasibility of a Modified E-PASS and POSSUM system for Postoperative Risk Assessment in Patients with Spinal Disease.

World Neurosurg. 2017 Dec 22;:

Authors: Chun DH, Kim DY, Choi SK, Shin DA, Ha Y, Kim KN, Yoon DH, Yi S

Abstract
STUDY DESIGN: Retrospective case control study OBJECTIVE: This study aimed to evaluate the feasibility of using Estimation of Physiological Ability and Surgical Stress (E-PASS) and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) systems in patients undergoing spinal surgical procedures.
SUMMARY OF BACKGROUND DATA: Degenerative spine disease has increased in incidence in aging societies, as has the number of older adult patients undergoing spinal surgery. Many older adults are at a high surgical risk because of comorbidity and poor general health.
METHODS: We retrospectively reviewed 217 patients who had undergone spinal surgery at a single tertiary care. We investigated complications within one month after surgery. Criteria for both skin incision in E-PASS and operation magnitude in the POSSUM system were modified to fit spine surgery. We calculated the E-PASS and POSSUM scores for enrolled patients, and investigated the relationship between postoperative complications and both surgical risk scoring systems. To reinforce the predictive ability of the E-PASS system, we adjusted equations and developed modified E-PASS systems.
RESULTS: The overall complication rate for spinal surgery was 22.6%. Forty-nine patients experienced 58 postoperative complications. Nineteen major complications, including hematoma, deep infection, pleural effusion, progression of weakness, pulmonary edema, esophageal injury, myocardial infarction, pneumonia, re-operation, renal failure, sepsis, and death, occurred in 17 patients. The area under the receiver operating characteristic curve (AUC) for predicted postoperative complications after spine surgery was 0.588 for E-PASS and 0.721 for POSSUM. For predicted major postoperative complications, the AUC increased to 0.619 for E-PASS and 0.842 for POSSUM. The AUC of the E-PASS system increased from 0.588 to 0.694 with the Modified E-PASS equation.
CONCLUSION: The POSSUM system may be more useful for estimating postoperative surgical risk in patients undergoing spine surgery than the E-PASS system. The preoperative risk scores of E-PASS and POSSUM can be useful for predicting postoperative major complications. To enhance the predictability of the scoring systems, use of modified equations based on spine surgery-specific factors may help ensure surgical outcomes and patient safety.

PMID: 29277590 [PubMed - as supplied by publisher]

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