PURPOSE: This study was designed to develop a model for predicting postoperative mortality in elderly patients undergoing surgery for colorectal cancer. METHODS: This multicenter study was conducted by using routinely...PURPOSE: This study was designed to develop a model for predicting postoperative mortality in elderly patients undergoing surgery for colorectal cancer. METHODS: This multicenter study was conducted by using routinely collected clinical data, assessing patients older than aged 80 years, with 30-day operative mortality as the primary end point. Data were collected from The Association of Coloproctology of Great Britain and Ireland database, encompassing 8,077 newly diagnosed colorectal cancer patients undergoing resectional surgery in 79 hospitals between April 2000 to March 2002, The Association of Coloproctology Malignant Bowel Obstruction Study,encompassing 1,046 patients with malignant bowel obstruction in 148 hospitals, between April 1998 to March 1999, and The Wales-Trent audit, encompassing 3,522 newly diagnosed colorectal cancer patients, between July 1992 to June 1993. A multilevel logistic regression model was developed to adjust for case mix and to accommodate the variability of outcomes between the three study populations. The model was internally validated using a Bayesian resampling technique and tested using measures of discrimination, calibration, and subgroup analysis. RESULTS: A total of 2,533 patients satisfied the inclusion criteria, with a 30-day mortality of 15.6 percent. Multivariate analysis identified the following independent risk factors: age (odds ratio for 85-90, 90-95, >95 vs. 80-85 = 1.1, 1.8, 2.9), American Society of Anesthesiology grade (odds ratio for Grade Ⅲ, IV vs. I-Ⅱ = 2.7, 6.1), operative urgency (odds ratio for emergency vs. elective = 1.9), no cancer excision vs. resection (odds ratio = 1.2), and metastatic disease (odds ratio for metastases vs. no metastases = 1.9). The model offered adequate discrimination (area under receiver operator curve = 0.732) and excellent agreement between observed and predicted outcomes during eight colorectal procedures (P = 0.885). CONCLUSIONS: The elderly colorectal cancer model can accurately estimate 30-day mortality in patients older than aged 80 years undergoing surgery for colorectal cancer. Because the mortality can be considerable, this may have important implications when determining management for this group of patients.展开更多
PURPOSE:POSSUM(Physiologic and Operative Severity Score for enumeration of Morbidity &Mortality)and P-POSSUM have been validated as scoring tools for the prediction of postoperative complications in general surgic...PURPOSE:POSSUM(Physiologic and Operative Severity Score for enumeration of Morbidity &Mortality)and P-POSSUM have been validated as scoring tools for the prediction of postoperative complications in general surgical patients.More recently a colorectal-specific POSSUM has been developed for mortality prediction.This study was designed to evaluate and compare the accuracy for mortality prediction of POSSUM,P-POSSUM,and colorectal POSSUM after major and complex major colorectal procedures.METHODS:The relationship between the observed and expected morbidity and mortality was examined in 347 consecutive patients(321 elective,26 urgent)undergoing amajor or complex major colorectal resection using POSSUM,P-POSSUM,and Colorectal POSSUM.The accuracy of using these scoring tools to predict mortality was assessed using Receiver Operator Characteristic curve analysis.RESULTS:A total of 347 consecutive patients(median age,69(range,34-92)years)were assessed.Seventy-one patients(20.5 percent)suffered a postoperative complication and 15 patients(4.3 percent)died.The observed∶expected POSSUM ratio for morbidity was 0.71 and mortality 0.68.The area under curve from Receiver Operator Characteristic curve analysis for POSSUM was 0.752.The observed∶expected mortality ratio for P-POSSUM was 0.71,and the area under curve from Receiver Operator Characteristic curve analysis was 0.749.The observed∶expected mortality ratio for colorectal POSSUM was 0.75,and the area under the curve from Receiver Operator Characteristic curve analysis was 0.781.CONCLUSIONS:Colorectal POSSUM provides comparable prediction of mortality risk after colorectal resection compared with POSSUM and P-POSSUM.展开更多
文摘PURPOSE: This study was designed to develop a model for predicting postoperative mortality in elderly patients undergoing surgery for colorectal cancer. METHODS: This multicenter study was conducted by using routinely collected clinical data, assessing patients older than aged 80 years, with 30-day operative mortality as the primary end point. Data were collected from The Association of Coloproctology of Great Britain and Ireland database, encompassing 8,077 newly diagnosed colorectal cancer patients undergoing resectional surgery in 79 hospitals between April 2000 to March 2002, The Association of Coloproctology Malignant Bowel Obstruction Study,encompassing 1,046 patients with malignant bowel obstruction in 148 hospitals, between April 1998 to March 1999, and The Wales-Trent audit, encompassing 3,522 newly diagnosed colorectal cancer patients, between July 1992 to June 1993. A multilevel logistic regression model was developed to adjust for case mix and to accommodate the variability of outcomes between the three study populations. The model was internally validated using a Bayesian resampling technique and tested using measures of discrimination, calibration, and subgroup analysis. RESULTS: A total of 2,533 patients satisfied the inclusion criteria, with a 30-day mortality of 15.6 percent. Multivariate analysis identified the following independent risk factors: age (odds ratio for 85-90, 90-95, >95 vs. 80-85 = 1.1, 1.8, 2.9), American Society of Anesthesiology grade (odds ratio for Grade Ⅲ, IV vs. I-Ⅱ = 2.7, 6.1), operative urgency (odds ratio for emergency vs. elective = 1.9), no cancer excision vs. resection (odds ratio = 1.2), and metastatic disease (odds ratio for metastases vs. no metastases = 1.9). The model offered adequate discrimination (area under receiver operator curve = 0.732) and excellent agreement between observed and predicted outcomes during eight colorectal procedures (P = 0.885). CONCLUSIONS: The elderly colorectal cancer model can accurately estimate 30-day mortality in patients older than aged 80 years undergoing surgery for colorectal cancer. Because the mortality can be considerable, this may have important implications when determining management for this group of patients.
文摘PURPOSE:POSSUM(Physiologic and Operative Severity Score for enumeration of Morbidity &Mortality)and P-POSSUM have been validated as scoring tools for the prediction of postoperative complications in general surgical patients.More recently a colorectal-specific POSSUM has been developed for mortality prediction.This study was designed to evaluate and compare the accuracy for mortality prediction of POSSUM,P-POSSUM,and colorectal POSSUM after major and complex major colorectal procedures.METHODS:The relationship between the observed and expected morbidity and mortality was examined in 347 consecutive patients(321 elective,26 urgent)undergoing amajor or complex major colorectal resection using POSSUM,P-POSSUM,and Colorectal POSSUM.The accuracy of using these scoring tools to predict mortality was assessed using Receiver Operator Characteristic curve analysis.RESULTS:A total of 347 consecutive patients(median age,69(range,34-92)years)were assessed.Seventy-one patients(20.5 percent)suffered a postoperative complication and 15 patients(4.3 percent)died.The observed∶expected POSSUM ratio for morbidity was 0.71 and mortality 0.68.The area under curve from Receiver Operator Characteristic curve analysis for POSSUM was 0.752.The observed∶expected mortality ratio for P-POSSUM was 0.71,and the area under curve from Receiver Operator Characteristic curve analysis was 0.749.The observed∶expected mortality ratio for colorectal POSSUM was 0.75,and the area under the curve from Receiver Operator Characteristic curve analysis was 0.781.CONCLUSIONS:Colorectal POSSUM provides comparable prediction of mortality risk after colorectal resection compared with POSSUM and P-POSSUM.
