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A multicenter prospective study of surgical audit systems
Yoshio Haga1, Koji Ikejiri, Yasuo Wada
1Department of Surgery, National Hospital Organization (NHO) Kumamoto Medical Center, Kumamoto, Japan Japan.yoshio@kumamoto.hosp.go.jp
Annals of Surgery
|January 15, 2011
Summary
A modified surgical audit tool, mE-PASS, demonstrated high accuracy and ease of use. This validated system is suitable for nationwide surgical risk assessment and mortality prediction.
Area of Science:
- Surgical audit and risk assessment.
- Development and validation of predictive models in healthcare.
Background:
- Existing surgical audit scoring systems lack nationwide validation.
- The need for a reliable and generalizable tool for surgical risk assessment.
Purpose of the Study:
- To evaluate a modified Estimation of Physiologic Ability and Surgical Stress (mE-PASS) score for surgical audit.
- To compare the performance of mE-PASS against existing models like E-PASS, P-POSSUM, and ASA status.
Main Methods:
- Modification of the E-PASS system (mE-PASS) using data from 4925 elective digestive surgery patients.
- Prospective cohort study in 43 Japanese national hospitals (2005-2007) involving 5272 patients.
- Evaluation of discrimination (AUC) and quality (OE ratio) for in-hospital mortality prediction.
Main Results:
- mE-PASS requires fewer variables (7) compared to E-PASS (10) and P-POSSUM (20).
- mE-PASS achieved an AUC of 0.86 (0.79-0.92), comparable to E-PASS (0.86) and superior to P-POSSUM (0.81) and ASA (0.73).
- OE ratios for mE-PASS correlated well with other models in large-volume hospitals.
Conclusions:
- The modified E-PASS (mE-PASS) system is accurate, generalizable, and easy to use.
- mE-PASS is a strong candidate for nationwide surgical audit surveys.
- This validated tool can improve surgical risk assessment and patient outcomes.
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