Abstract
Several postoperative outcome scoring systems have been developed and validated, combining both pre- and intraoperative factors. Among others are The Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM), the Estimation of Physiologic Ability and Surgical Stress (E-PASS), and the Surgical Apgar Score combined with the American Society of Anesthesiologists (SASA) physical status classification. The aim of this study is to compare the above scoring systems in the prediction of 30-day postoperative mortality and major morbidity in older patients undergoing emergency abdominal surgery. Patients ≥ 65 years were enrolled into the study. Pre- and intraoperative variables were used to calculate the scores and the ROC curve; logistic regression analysis was performed. The study sample comprised 427 older patients with a median age of 77 (range 65–100) years. The most frequent surgical indications were cholecystitis, followed by ileus, complication of colorectal cancer, complicated diverticulitis, and appendicitis. Decreasing SASA and increasing E-PASS and POSSUM/P-POSSUM scores were significantly associated with both 30-day postoperative major complications and death. Multivariate analyses identified all the scores as independent variables to predict postoperative outcomes. The areas under the ROC curve were 0.66–0.81 for predicting mortality and 0.67–0.79 for predicting morbidity (p < 0.01). All the scores were confirmed to be predictive of 30-day postoperative morbidity and mortality. The SASA and the E-PASS scores demonstrated the highest discriminatory ability. However, SASA was found to combine effectiveness and simplicity. Based on this study, we therefore recommend SASA for postoperative risk evaluation in older patients undergoing emergency abdominal surgery.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Robinson TN, Eiseman B, Wallace JI et al (2009) Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg 250:449–455
Copeland GP, Jones D, Walters M (1991) POSSUM: a scoring system for surgical audit. Br J Surg 78:355–360
Whiteley MS, Prytherch DR, Higgins B et al (1996) An evaluation of the POSSUM surgical scoring system. Br J Surg 83:812–815
Prytherch DR, Whiteley MS, Higgins B, Weaver PC, Prout WG, Powell SJ (1998) POSSUM and Portsmouth POSSUM for predicting mortality. Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity. Br J Surg 85(9):1217e20
Haga Y, Ikei S, Ogawa M (1999) Estimation of Physiologic Ability and Surgical Stress (E-PASS) as a new prediction scoring system for postoperative morbidity and mortality following elective gastrointestinal surgery. Surg Today 29(3):219–225
Oka Y, Nishijima J, Oku K, Azuma T, Inada K, Miyazaki S, Nakano H, Nishida Y, Sakata K, Izukura M (2005) Usefulness of an estimation of physiologic ability and surgical stress (E-PASS) scoring system to predict the incidence of postoperative complications in gastrointestinal surgery. World J Surg 29(8):1029–1033
Kinoshita M, Morioka N, Yabuuchi M, Ozaki M (2017) New surgical scoring system to predict postoperative mortality. J Anesth 31:198–205
Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ (2007) An Apgar score for surgery. J Am Coll Surg 204:201–208
Nair A, Bharuka A, Rayani BK (2017) The reliability of Surgical Apgar Score in predicting immediate and late postoperative morbidity and mortality: a narrative review. Rambam Maimonides Med J. https://doi.org/10.5041/RMMJ.10316
Kenig J, Mastalerz K, Lukasiewicz K, Mitus-Kenig M, Skorus U (2018) The Surgical Apgar Score predicts outcomes of emergency abdominal surgeries both in fit and frail older patients. Arch Gerontol Geriatr 76:54–59
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Oliver CM, Walker E, Giannaris S, Grocott MPW, Moonesinghe SR (2015) Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. Br J Anaesth 115(6):849–860
Koushi K, Korenaga D, Kawanaka H, Okuyama T, Ikeda Y, Takenaka K (2011) Using the E-PASS scoring system to estimate the risk of emergency abdominal surgery in patients with acute gastrointestinal disease. Surg Today 41:1481–1485
Itoh S, Kohnoe S, Shirabe K, Yoshida D, Kawanaka H, Yoshizumi T, Ikegami T, Yamashita Y, Kurihara T, Maehara Y (2016) Validity of hepatic or pancreatic resection for elderly patients aged 85 years or older at a single community hospital in Japan. Anticancer Res 36(8):4289–4292
Sato M, Endo K, Harada A, Yabuuchi S (2017) Potential risk factors for postoperative complications and deaths after laparoscopic cholecystectomy in the elderly. Nihon Shokakibyo Gakkai Zasshi 114(9):1649–1657
Sugi M, Harada J, Inui H, Nishida T, Kawakita S, Murota T, Kinoshita H, Matsuda T (2011 Nov) Feasibility of a modified E-PASS and POSSUM system for postoperative risk assessment in patients with spinal disease. [laparoscopic renal surgery in the elderly]. Hinyokika Kiyo 57(11):603–606
Fukuda N, Wada J, Niki M, Sugiyama Y, Mushiake H (2012) Factors predicting mortality in emergency abdominal surgery in the elderly. World J Emerg Surg 7(1):12. https://doi.org/10.1186/1749-7922-7-12
Tominaga T, Takeshita H, Takagi K, Kunizaki M, To K et al (2016) E-PASS score as a useful predictor of postoperative complications and mortality after colorectal surgery in elderly patients. Int J Colorectal Dis; New York Tom 31(Nr/wydanie 2):217–225
Kenig J, Zychiewicz B, Olszewska U et al (2015) Six screening instruments for frailty in older patients qualified for emergency abdominal surgery. Arch Gerontol Geriatr 61:437–442
Lamb P, Sivashanmugam T, White M et al (2008) Gastric cancer surgery–a balance of risk and radicality. Ann R Coll Surg Engl 90:235–242
Zhang A, Liu T, Zheng K, Liu N, Huang F, Li W, Liu T, Fu W (2017) Estimation of physiologic ability and surgical stress (E-PASS) scoring system could provide preoperative advice on whether to undergo laparoscopic surgery for colorectal cancer patients with a high physiological risk. Medicine (Baltimore) 96(33):777–780
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The Ethics Committee of the Jagiellonian University approved this study and informed consent was obtained from all patients or their caregivers.
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Jakub, K., Kinga, M., Kinga, S. et al. Mortality and Morbidity Prediction for Older Patients Undergoing Emergency Abdominal Surgery—Comparison of the POSSUM, E-PASS Score, and SASA Score. Indian J Surg 82, 551–558 (2020). https://doi.org/10.1007/s12262-019-02027-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-019-02027-7