Assessment of postoperative complications using E-PASS and APACHE II in patients undergoing oral and maxillofacial surgery

Kiyohide Ishihata,Norifumi Nakamura,Etsuro Nozoe,Juri Murakami,Soichiro Toyodome,Takuya Yoshimura,Hiroshi Hijioka,Yasuyuki Kakihana

doi:10.1186/s13037-018-0152-6

Abstract

BackgroundThe prediction of postoperative complications is important for oral and maxillofacial surgeons. We herein aimed to evaluate the efficacy of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) and Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II scoring systems to predict postoperative complications in patients undergoing oral and maxillofacial surgery.MethodsThirty patients (22 males, 8 females; mean age: 65.1 ± 12.9 years) who underwent major oral surgeries and stayed in the intensive care unit for postoperative management were enrolled in this study. Postoperative complications were discriminated according to the necessity of the therapeutic intervention by the Medical Department, i.e. according to the Clavien–Dingo classification. E-PASS and APACHE II scores as well as laboratory test values were compared between patients with/without postoperative complications.ResultsPostoperative complications were developed in seven patients. The comprehensive risk score (CRS: 1.13 ± 0.24) and APACHE II score (13.0 ± 2.58) were significantly higher in patients with postoperative complications than in those without ones (p < 0.01, p < 0.05, respectively). The CRS showed an appropriate discriminatory power for predicting postoperative complications (area under the curve: 0.814). Furthermore, a correlation was detected between APACHE II scores and postoperative data until C-reactive protein levels decreased to < 1.0 mg/L (r = 0.43, p < 0.05).ConclusionThe E-PASS and APACHE II scoring systems were both shown to be useful to predict postoperative complications after oral and maxillofacial surgery.

Highlights

The prediction of postoperative complications is important for oral and maxillofacial surgeons
The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score consists of three parts for estimation of physiologic ability (PRS), surgical stress (SSS), and their comprehensive score(CRS)
In the present study, we evaluated the efficacy of the E-PASS and acute physiology and chronic health evaluation (APACHE) II scoring systems to predict postoperative complications in the field of oral and maxillofacial surgery

Summary

Introduction

The prediction of postoperative complications is important for oral and maxillofacial surgeons. We aimed to evaluate the efficacy of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) and Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II scoring systems to predict postoperative complications in patients undergoing oral and maxillofacial surgery. Ishihata et al Patient Safety in Surgery (2018) 12:3 withstand surgical stress, homeostasis may collapse, and as a consequence, various postoperative complications may develop Postoperative complications such as surgical site infection (SSI), aspiration pneumonia, and swallowing and breathing difficulties have a significant impact on the prognosis of patients, and as a result, increase health care costs and hospitalization [3]. The estimation of physiologic ability and stress (E-PASS) scoring system is a useful and simple strategy to predict postoperative mortality and morbidity [2, 4] It evaluates the physiological condition of a patient and surgical invasion and precisely reflects the general condition of a patient in a perioperative setting. Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II, a severity of disease classification system that use basic physiological principles, has frequently been applied in many Intensive Care Units (ICU) to stratify prognosis of acute ill patients [5, 6]

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