Evaluation of Modified Estimation of Physiologic Ability and Surgical Stress in Colorectal Carcinoma Surgery

BACKGROUND: We recently modified Estimation of Physiologic Ability and Surgical Stress, our prediction scoring system. OBJECTIVE: This study evaluated the usefulness of our modified version for colorectal carcinoma in comparison with existing models. DESIGN: This investigation studied a multicenter cohort. SETTINGS: The study was conducted in regional referral hospitals in Japan. PATIENTS: Patients were included who underwent elective surgery for colorectal carcinoma. MAIN OUTCOME MEASURES: Postoperative morbidity, mortality, and predicted mortality rates for original and modified Estimation of Physiologic Ability and Surgical Stress were investigated in 2388 patients in comparison with existing European models. RESULTS: Among the models, the modified Estimation of Physiologic Ability and Surgical Stress demonstrated the highest discriminatory power in terms of in-hospital mortality (area under receiver operating characteristic curve: 0.84 for Estimation of Physiologic Ability and Surgical Stress, 0.87 for modified Estimation of Physiologic Ability and Surgical Stress, 0.84 for Portsmouth modification of POSSUM, 0.74 for ASA status-based model), as well as 30-day mortality (area under receiver operating characteristic curve: 0.82 for Estimation of Physiologic Ability and Surgical Stress, 0.84 for modified Estimation of Physiologic Ability and Surgical Stress, 0.81 for POSSUM, 0.78 for colorectal POSSUM, 0.76 for Association of Coloproctology of Great Britain and Ireland score). British models, in general, overpredicted postoperative mortality rates by more than 10 times. LIMITATIONS: The current study analyzed only the Japanese population treated in medium-volume centers. CONCLUSIONS: Among the models, modified Estimation of Physiologic Ability and Surgical Stress was the most accurate in predicting postoperative mortality in colorectal carcinoma surgery. These findings should be validated in Western populations, because the Japanese population may differ from Western populations in terms of body shape or reserve capacity.