A study of E-PASS score to predict the risk of postoperative complications and prolonged hospital stay in patients with tibial plateau fractures

WANG Ming-xing; LI Jie; HU Yue; JIA Yu; LI Qi

doi:10.3969/j.issn.2095-252X.2025.04.012

Abstract：Objective To analyse the estimation of physiologic ability and surgical stress(E-PASS)system in relation to postoperative complications and length of hospital stay in patients with tibial plateau fractures(TPF).Methods 155 patients with TPF who were surgically treated between January 2022 and May 2024 in our hospital were selected.Preoperative Risk Score(PRS),Surgical Stress Score(SSS),and Composite Risk Score(CRS)of the E-PASS score were calculated based on preoperative and intraoperative clinical data.Postoperative complications were defined and categorised according to the presence or absence of complications within 30 d postoperatively.Prolonged length of stay(PLOS)was defined and classified by exceeding the 75th percentile of all patients with length of stay.Receiver operating characteristic(ROC)curve analysis variables were used to predict postoperative complications and PLOS accuracy.Independent risk factors for postoperative complications and PLOS were analysed using multifactorial logistic regression models.Results Postoperative complications occurred in 29(18.6%)patients.39(25.2%)patients had PLOS.ROC curve analysis showed that the area under the curve(AUC)for PRS,SSS and CRS predicting postoperative complications was 0.849(0.790-0.896),0.614(0.545-0.679)and 0.869(0.813-0.913),respectively;the AUCs of PRS,SSS and CRS for predicting PLOS were 0.853(0.796-0.900),0.611(0.539-0.680)and 0.855(0.798-0.901),respectively.The results of multifactorial logistic regression analysis showed that body mass index,C-reactive protein(CRP),PRS,and CRS were independent risk factors for postoperative complications in patients with TPF(P<0.05);albumin,CRP,PRS,and CRS were independent risk factors for PLOS in patients(P<0.05).The ROC curves of BMI,CRP,and BMI+CRP+CRS predicting postoperative complications were 0.761(0.685-0.825),0.686(0.606-0.758),and 0.935(0.883-0.968),respectively;and the ROC curves for Alb,CRP,and Alb+CRP+CRS predicting PLOS with AUCs of 0.816(0.745-0.873),0.718(0.640-0.787)and 0.906(0.849-0.947).Conclusions The E-PASS score effectively assesses the surgical risk of TPF patients and helps to optimise the perioperative treatment plan for clinical staff.