ObjectiveIn-hospital mortality and major morbidity following pancreatic resections has dropped significantly over the past decade. Single factors such as preoperative jaundice or renal or hepatic co-morbidity have been found to be associated with a worse outcome in various studies. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score was designed on the premise that the balance between the patient's physiologic reserve capacity and the surgical stress may determine postoperative morbidity and mortality. The initial calculation of the E-PASS included among 1281 patients only 32 (2.4%) patients undergoing pancreaticoduodenectomy. Our aim was to review whether the E-PASS scoring system could be used without restrictions in elective pancreatic surgery as a means of correctly predicting morbidity and mortality. MethodsRelevant data of all patients undergoing pancreatic surgery at our institution are entered in a prospectively recorded statistical database. E-PASS data items were computed retrospectively and operative morbidity and mortality rates were compared with the preoperative risk score (PRS), surgical stress score (SSS) and comprehensive risk score (CRS) of E-PASS. The relationship of the CRS to the incidence of morbidity and mortality was retrospectively examined and Receiver operating characteristics (ROC curve) were calculated.ResultsBetween January 2002 and October 2007 a total of 305 consecutive patients were operated on pancreatic lesions. Median age was 63 (range 18-86), median BMI was 24kg/m2 (range 15-38). 198 patients underwent pancreatic head resections (65%), 58 distal resections (19%), 17 total pancreatectomies (5%) and 30 other types of resection (11%). There were 9 deaths (2.9%) and 105 patients (34.5%) had complications postoperatively. Mean CRS in the groups of patients who survived and died were 0.47 (+/-0.28) and 0.75 (+/-0.43), respectively (p<0.01). PRS, SSS, and CRS all failed to predict mortality and morbidity as demonstrated by low areas under the ROC curve (range 0.500 to 0.595). Neither did CRS show a linear association with length of hospital stay.ConclusionThe E-PASS scoring system appears to be ineffective in predicting postoperative morbidity and mortality in patients undergoing elective pancreatic surgery. Thus, further refinements focusing on problems specific for patients undergoing pancreatic resections may be warranted in order to delineate differences in immediate surgical outcome.