Key result
The SASA, E-PASS, and P-POSSUM scoring systems independently predicted 30-day postoperative mortality (AUC 0.60-0.77), but only SASA independently predicted 30-day major morbidity.
Why the study?
The study aimed to compare P-POSSUM, E-PASS, and SASA scoring systems in predicting 30-day postoperative outcomes in older cancer patients undergoing abdominal surgery.
Do P-POSSUM, E-PASS, and SASA scoring systems predict 30-day postoperative outcomes in older cancer patients undergoing abdominal surgery?
Observational (n=201)
Do P-POSSUM, E-PASS, and SASA scoring systems predict 30-day postoperative outcomes in older cancer patients undergoing abdominal surgery?
Effect estimate: AUC 0.60-0.77
SASA, E-PASS, and P-POSSUM predict 30-day mortality in older patients undergoing abdominal cancer surgery, but only SASA predicts major morbidity.
SASA, E-PASS, and P-POSSUM predict 30-day mortality after abdominal cancer surgery in older adults; supports risk stratification but leaves optimal tool selection open.
BACKGROUND: 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 Stress (E-PASS) and the Surgical Apgar Score combined with the American Society of Anesthesiologists physical status classification (SASA). The aim of this study was to compare the above scoring systems in the prediction of 30-day postoperative outcome in older patients with cancer undergoing abdominal surgery. METHODS: Consecutive patients ≥70 years were prospectively enrolled. Pre- and intraoperative variables were used to calculate the scores, the ROC and perform logistic regression analysis. RESULTS: The study sample comprised 201 patients with a median age of 77 (range 70-93) years. The most common surgical procedure was for colorectal (75%), followed by gastric (10.4%) pancreas (7.0%), gall bladder (3.5%), small bowel (2.5%), and other (1.5%) types of cancer. All scores were independent predictors of 30-day postoperative mortality. In case of 30-day morbidity only SASA turned to be significant. The ROC curves were highly valid and area under the curve showed fair to good discriminatory ability (0.60-0.77) for 30-day postoperative mortality and fair (AUC 0.6) in case of SASA for the 30-day postoperative. CONCLUSION: The SASA, E-PASS, and P-POSSUM were confirmed to be predictive of 30-day postoperative mortality in older patients undergoing abdominal elective cancer surgery. Only SASA demonstrated as independent factor predicting postoperative 30-day major morbidity.
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Kenig et al. (2019) conducted an observational in cancer undergoing abdominal surgery (n=201). Postoperative outcome scoring systems (SASA, E-PASS, P-POSSUM) was evaluated on 30-day postoperative mortality and morbidity (AUC 0.60-0.77). The SASA, E-PASS, and P-POSSUM scoring systems independently predicted 30-day postoperative mortality (AUC 0.60-0.77), but only SASA independently predicted 30-day major morbidity.
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