Detailed Abstract
[Liver Poster Presentation 2 - Liver (Liver Disease/Surgery)]
[LV PP 2-6] Estimation Of Physiologic Ability And Surgical Stress (E-PASS) Predicts Postoperative Major Complications After Hepato-pancreato Biliary Surgery In The Elderly
Yu NORIMATSU1 , Kyoji ITO1 , Nobuyuki TAKEMURA*1 , Yuhi YOSHIZAKI1 , Mai NAKAMURA1 , Fuyuki INAGAKI1 , Fuminori MIHARA1 , Norihiro KOKUDO1
1 Surgery, National Center For Global Health And Medicine, JAPAN
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 elderly patients ≥65 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). The same analysis was performed for patients ≥75 and for patients ≥65 who had undergone highly invasive surgery (hepatic lobectomy, pancreatoduodenectomy, and total pancreatectomy).
Results : A total of 184 were collected, and complications occurred in 78 (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. In the subgroup analysis, E-PASS was effective, and pancreatic surgery additionally was an independent factor.
Conclusions : E-PASS is a useful model for predicting complications in elderly patients undergoing HPB surgery.
Methods : We retrospectively investigated elderly patients ≥65 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). The same analysis was performed for patients ≥75 and for patients ≥65 who had undergone highly invasive surgery (hepatic lobectomy, pancreatoduodenectomy, and total pancreatectomy).
Results : A total of 184 were collected, and complications occurred in 78 (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. In the subgroup analysis, E-PASS was effective, and pancreatic surgery additionally was an independent factor.
Conclusions : E-PASS is a useful model for predicting complications in elderly patients undergoing HPB surgery.
SESSION
Liver Poster Presentation 2
Poster Presentation 3/24/2023 2:50 PM - 3:50 PM