E-PASS Scoring System in Predicting Postoperative Complications After Penile Prosthesis Implantation

Complications related to penile prosthesis implantation surgery (PPI) can be categorized as infectious, non-infectious organ/tissue damage, device failure, and patient/partner dissatisfaction. However, no scoring system has been established to assess both preoperative physical status and intraoperative risk factors. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score was originally developed to estimate postoperative complication risk in gastrointestinal surgeries. It incorporates age, severe cardiac/pulmonary disease, diabetes mellitus, performance status index, American Society of Anesthesiologists (ASA) classification, blood loss, body weight, operative time, and skin incision length. This study aims to evaluate the feasibility of the E-PASS scoring system in predicting postoperative complications following PPI.

In this single-center retrospective study, data of 56 patients who underwent PPI between 2015 and 2024 were analyzed. Demographics, preoperative physical condition parameters, and intraoperative risk factors were recorded. E-PASS score and sub-scores were calculated.

Postoperative complications occurred in 17 patients (30.4%). Patients with complications had higher performance scores, ASA scores, prior pelvic/penile/urethral surgeries, prior PPI history, and higher E-PASS scores (preoperative risk score, surgical stress score, and comprehensive risk score [CRS]). A CRS cut-off value of -0.1238 predicted complications (AUC = 0.75; 95% CI 0.62-0.88; p < 0.003). CRS above the cut-off was associated with a 16.2-fold increase in complication risk.

The E-PASS scoring system appears to be a reliable tool for predicting postoperative complications in patients undergoing PPI by incorporating both preoperative physical condition and intraoperative risk factors.