Estimation of Physiologic Ability and Surgical Stress (E-PASS) Predicts Postoperative Major Complications After Hepato-Pancreato Biliary Surgery in the Elderly

Background As society ages, an increasing number of elderly patients require hepato–pancreato–biliary (HPB) surgery. We investigated the risk factors for complications in elderly patients undergoing HPB surgery using surgical risk scoring models. Methods We retrospectively investigated 184 elderly patients (≥ 65 years old) who underwent HPB surgery, including the liver, pancreas, bile duct, and/or gallbladder resection, with exemption to simple cholecystectomy between January 2017 and December 2019. The surgical risk scoring models used included the Estimation of Physiological Ability and Surgical Stress (E-PASS), Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM), and Geriatric 8 (G8). We evaluated the correlations between the scores and severe complications. Complications were classified as severe (Clavien–Dindo classification [C–D] ≥ III) or non-severe (C–D ≤ II). Results Complications occurred in 78 patients (24 C–D ≥ III, 54 C–D ≤ II). Preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) were significantly higher in patients with C–D ≥ IIIa than in those with C–D ≤ II. Multiple logistic regression analysis revealed that PRS ( P = 0.01) and SSS ( P = 0.04) were independent predictive factors for severe complications. However, the POSSUM and G8 models showed no significant correlations to severe complications. Conclusion E-PASS is a useful model for predicting complications in elderly patients undergoing HPB surgery.