Clinical study of E-PASS system for peri-operative morbidity of spinal surgery for degenerative scoliosis
10.3760/cma.j.issn.0253-2352.2019.20.005
- VernacularTitle: 生理能力与手术应激评分系统预测退变性脊柱侧凸围手术期并发症的临床研究
- Author:
Hai WANG
1
;
Guixing QIU
;
Jianguo ZHANG
Author Information
1. Department of Orthopaedics, Peking Union Medical College Hospital (PUMCH), Beijing 100730, China
- Publication Type:Journal Article
- Keywords:
Adult;
Lumbar vertebrae;
Intervertebral disc degeneration;
Scoliosis;
Spinal fusion;
Intraoperative complications;
Postoperative complications
- From:
Chinese Journal of Orthopaedics
2019;39(20):1257-1263
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the feasibility of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) system to predict peri-operative risk in degenerative scoliosis patients scheduled for spinal surgery.
Methods:Clinical data of 227 cases with degenerative scoliosis (Male∶Female=57∶170, Mean age=66.2±7.7 years), who accepted the operation of instrumentation and fusion in our hospital from January 2013 to July 2017, were retrospectively reviewed according to the E-PASS system, including peri-operative complications. Both hospital stayand post-operative hospital staywere compared between the groups with and withoutthe complications using t test. All E-PASS scores, including Preoperative Risk Score (PRS), Surgical Stress Score (SSS) and Comprehensive Risk Score (CRS), were analyzed between the two groups using Mann-Whitney Utest.The relationship between complications and PRS, SSS and CRS were analyzed using Spearmancorrelation analysis. The predictiveaccuracy of PRS, SSS and CRS were analyzed using the area under the receiver operating characteristic (ROC) curve (AUC).
Results:There were a total of 47 patients (20.7%) suffering peri-operative complications, including 27 cases (11.9%) with complications at surgical sites and 23 cases (10.1%) with complications at non-surgical sites. Both hospital stay (t=-4.722, P<0.001)and post-operative hospital stay (t= -4.867, P<0.001) were increased because of the complications. All E-PASS scores, including PRS (P=0.005), SSS (P=0.003) and CRS (P<0.001) were significantly higher in patients with peri-operative complications and they were linearly correlated with the overall incidence of the complications(ρ=0.185-0.259). In particular, PRS was correlated with complications at non-surgical sites (ρ=0.162) and SSS with surgical site complications(ρ=0.162). The area under the receiver operating characteristic curve (AUC) for PRS and SSS was higher in patients with complications at non-surgical and surgical sites (AUC=0.655 and 0.650), respectively.The AUC for CRS exhibited good predictive power for both types of complications (AUC=0.662 and 0.631).
Conclusion:The peri-operative morbidity of spinal surgery for degenerative scoliosis was relatively higher. The E-PASS system could correctly predict the morbidity.
