Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2024; 16(1): 215-227
Published online Jan 27, 2024. doi: 10.4240/wjgs.v16.i1.215
Estimation of Physiologic Ability and Surgical Stress scoring system for predicting complications following abdominal surgery: A meta-analysis spanning 2004 to 2022
Tian-Shu Pang, Li-Ping Cao
Tian-Shu Pang, Li-Ping Cao, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Author contributions: Pang TS and Cao LP contributed equally to this work; Pang TS and Cao LP collected the data together; Pang TS designed the study and wrote the manuscript; Cao LP performed the research and analyzed the data; and all authors have read and approve the final manuscript.
Supported by Medical Science and Technology Project of Zhejiang Province of China, No. 2020PY053.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Ping Cao, MD, Chief Doctor, Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 Qingchun Road, Hangzhou 310016, Zhejiang Province, China. caolipingzju@zju.edu.cn
Received: August 31, 2023
Peer-review started: August 31, 2023
First decision: November 9, 2023
Revised: November 24, 2023
Accepted: December 19, 2023
Article in press: December 19, 2023
Published online: January 27, 2024
Processing time: 146 Days and 21.2 Hours
Abstract
BACKGROUND

Postoperative complications remain a paramount concern for surgeons and healthcare practitioners.

AIM

To present a comprehensive analysis of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system’s efficacy in predicting postoperative complications following abdominal surgery.

METHODS

A systematic search of published studies was conducted, yielding 17 studies with pertinent data. Parameters such as preoperative risk score (PRS), surgical stress score (SSS), comprehensive risk score (CRS), postoperative complications, postoperative mortality, and other clinical data were collected for meta-analysis. Forest plots were employed for continuous and binary variables, with χ2 tests assessing heterogeneity (P value).

RESULTS

Patients experiencing complications after abdominal surgery exhibited significantly higher E-PASS scores compared to those without complications [mean difference and 95% confidence interval (CI) of PRS: 0.10 (0.05-0.15); SSS: 0.04 (0.001-0.08); CRS: 0.19 (0.07-0.31)]. Following the exclusion of low-quality studies, results remained valid with no discernible heterogeneity. Subgroup analysis indicated that variations in sample size and age may contribute to heterogeneity in CRS analysis. Binary variable meta-analysis demonstrated a correlation between high CRS and increased postoperative complication rates [odds ratio (OR) (95%CI): 3.01 (1.83-4.95)], with a significant association observed between high CRS and postoperative mortality [OR (95%CI): 15.49 (3.75-64.01)].

CONCLUSION

In summary, postoperative complications in abdominal surgery, as assessed by the E-PASS scoring system, are consistently linked to elevated PRS, SSS, and CRS scores. High CRS scores emerge as risk factors for heightened morbidity and mortality. This study establishes the accuracy of the E-PASS scoring system in predicting postoperative morbidity and mortality in abdominal surgery, underscoring its potential for widespread adoption in effective risk assessment.

Keywords: Estimation of Physiologic Ability and Surgical Stress scoring system; Preoperative risk score; Surgical stress score; Comprehensive risk score; Complications

Core Tip: Excessive surgical stress surpassing the patient’s physiological thresholds could precipitate the occurrence of morbidity and mortality following abdominal surgery, especially for resection of liver, pancreas, spleen, and gastrointestinal tract. As a robust evaluation system, Estimation of Physiologic Ability and Surgical Stress scoring system has been widely recognized and adopted over 20 years. Whether the risk prediction score exhibit precise predictive capability of morbidity and mortality in patients undergoing abdominal surgery and provide a favorable evaluation for surgeons? This systematic review will present you with interesting viewpoints.