SPECIAL POSTER PRESENTATIONS

SP2. VALIDATION OF THE ESTIMATION OF PHYSIOLOGIC ABILITY AND SURGICAL

STRESS (E-PASS) IN THORACOLUMBAR INSTRUMENTED SPINE SURGERY FOR
ELDERLY PATIENTS
Togawa, Daisuke; Kanayama, Masahiro; Shigenobu, Keiichi; Oha, Fumihiro; Yamada,
Katsuhisa; Hashimoto, Tomoyuki
Hakodate Central General Hospital, Spine Center, Hokkaido, Japan
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INTRODUCTION: The Estimation of Physiologic Ability and Surgical Stress (E-PASS)

scoring system is comprised of a preoperative risk score (PRS), a surgical stress score
(SSS), and a comprehensive risk score (CRS) determined by PRS and SSS. E-PASS
scoring system was established to predict postoperative risk by quantifying the
patients preoperative general condition and surgical stress in general surgery. The
purpose of this study was to evaluate the usefulness of this scoring system for
thoracolumbar instrumented spine surgery in elderly patients.

METHODS: Forty-one patients with the age over 80 (15 male, 26 female, average age
81(80-94)) underwent instrumented thoracolumbar spine surgery between January
2009 and June 2010. General condition in these 41 patients evaluated by the
American Society of Anesthesiology physical status (ASA PS) were all in Class 2. The
pathologies of these patients included spinal canal and foraminal stenosis in 13 cases,
spondylolisthesis in 11 cases, degenerative scoliosis in 7 cases, vertebral collapse in 4
cases, thoracic dislocation fractures due to ankylosing spinal hyperostosis (ASH) in 2
cases, burst fracture in 2 cases, lumbar isthmic spondylolisthesis and spinal instability
after pyrogenic discitis in 1 case, respectively. PRS, SSS, and CRS of E-PASS was
calculated in each patient and evaluated whether the E-PASS score predicted the
incidence of postoperative complication.

RESULTS: Average PRS, SSS, and CRS in this series were 0.888, 0.067, and 0.515,
respectively. There were 4 cases (10%) with postoperative complications (1
pneumonia, 1 deep infection, 1 dural tear, 1 cerebral infarction). PRS, SSS, and CRS
was 1.138, 0.571, and 1.294 in pneumonia case, and 1.063, 0.840, and 0.815 in
cerebral infarction case, both were significantly higher scores than those of the cases
without complications.

DISCUSSION: The E-PASS seems to effectively predict morbidity after instrumented

thracolumbar surgery in elderly patients.