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
ARTICLE HIGHLIGHTS
Research background

Postoperative complications have always been a close concern to surgeons. Numerous studies affirm the simplicity and efficacy of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system, which demonstrates superior predictive capabilities for postoperative complications in hepatobiliary, pancreatic, and gastrointestinal surgeries compared to alternative models.

Research motivation

How can doctors exhibit precise predictive capability for the risk of morbidity and mortality in patients undergoing abdominal surgery?

Research objectives

The main objective is to present a comprehensive analysis of the E-PASS scoring system’s efficacy in predicting postoperative complications following abdominal surgery.

Research methods

A systematic search of published studies was conducted, yielding 17 studies with pertinent data. Preoperative risk score, surgical stress score, comprehensive risk score (CRS), postoperative complications, postoperative mortality, and other clinical data were collected for meta-analysis. Continuity variables and binary variables were analyzed using forest plots, and heterogeneity was evaluated by the χ2 test P value. Heterogeneity tests, P values (validity), and effect scales were analyzed using forest plots, and publication bias was evaluated using funnel plots. The literature data are divided into several subgroups according to different attributes, and the subgroup analysis of continuous variables and two categorical variables are analyzed respectively.

Research results

Patients experiencing complications after abdominal surgery exhibited significantly higher E-PASS scores compared to those without complications. 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, with a significant association observed between high CRS and postoperative mortality.

Research conclusions

The E-PASS scoring system is simple and practical to be used as a good model to predict the postoperative complications with accuracy, being expected to popularize effective risk assessment after abdominal surgery.

Research perspectives

We confirmed that the E-PASS scoring system can predict the postoperative morbidity and mortality of abdominal surgery with accuracy, worth to be popularized for effective risk assessment.