The estimation of physiologic ability and surgical stress (E-PASS) scoring system is comprised of a preoperative risk score (PRS), surgical stress score (SSS), and comprehensive risk score (CRS) determined by both the PRS and SSS. E-PASS predicts postsurgical risks by quantification of the patient's reserve and surgical stress, and was previously reported in relation to postoperative complications and the costs of hospital stay in elective gastrointestinal operations.We evaluated the usefulness of this scoring system for 119 consecutive patients who underwent surgery with osteosynthesis for proximal femoral fractures. The postoperative morbidity rates linearly increased as the PRS and CRS increased, and correlated significantly with both the PRS (ρ=0.4, P<0.01)and CRS (ρ=0.4, P=0.02). The costs of hospital stay also related significantly to the PRS (r=0.2, P=0.01) and CRS (r=0.27, P=0.006). These results suggest that E-PASS may be useful for predicting postsurgical risk, estimating medical expenses, and comparing surgical quality for surgical cases of proximal femoral fractures.