TY - JOUR

T1 - Prediction of the postoperative 90-day mortality after acute colorectal cancer surgery

T2 - development and temporal validation of the ACORCA model

AU - Degett, Thea Helene

AU - Christensen, Jane

AU - Dalton, Susanne Oksbjerg

AU - Bossen, Kristine

AU - Frederiksen, Kirsten

AU - Iversen, Lene Hjerrild

AU - Gögenur, Ismail

N1 - Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2021

Y1 - 2021

N2 - Purpose: The aim of this study was to develop and validate a model to predict 90-day mortality after acute colorectal cancer surgery. Methods: The model was developed in all patients undergoing acute colorectal cancer surgery in 2014–2016 and validated in a patient group operated in 2017 in Denmark. The outcome was 90-day mortality. Tested predictor variables were age, sex, performance status, BMI, smoking, alcohol, education level, cohabitation status, tumour localization and primary surgical procedure. Variables were selected according to the smallest Akaike information criterion. The model was shrunken by bootstrapping. Discrimination was evaluated with a receiver operated characteristic curve, calibration with a calibration slope and the accuracy with a Brier score. Results: A total of 1450 patients were included for development of the model and 451 patients for validation. The 90-day mortality rate was 19% and 20%, respectively. Age, performance status, alcohol, smoking and primary surgical procedure were the final variables included in the model. Discrimination (AUC = 0.79), calibration (slope = 1.04, intercept = 0.04) and accuracy (brier score = 0.13) were good in the developed model. In the temporal validation, discrimination (AUC = 0.80) and accuracy (brier score = 0.13) were good, and calibration was acceptable (slope = 1.19, intercept = 0.52). Conclusion: We developed prediction model for 90-day mortality after acute colorectal cancer surgery that may be a promising tool for surgeons to identify patients at risk of postoperative mortality.

AB - Purpose: The aim of this study was to develop and validate a model to predict 90-day mortality after acute colorectal cancer surgery. Methods: The model was developed in all patients undergoing acute colorectal cancer surgery in 2014–2016 and validated in a patient group operated in 2017 in Denmark. The outcome was 90-day mortality. Tested predictor variables were age, sex, performance status, BMI, smoking, alcohol, education level, cohabitation status, tumour localization and primary surgical procedure. Variables were selected according to the smallest Akaike information criterion. The model was shrunken by bootstrapping. Discrimination was evaluated with a receiver operated characteristic curve, calibration with a calibration slope and the accuracy with a Brier score. Results: A total of 1450 patients were included for development of the model and 451 patients for validation. The 90-day mortality rate was 19% and 20%, respectively. Age, performance status, alcohol, smoking and primary surgical procedure were the final variables included in the model. Discrimination (AUC = 0.79), calibration (slope = 1.04, intercept = 0.04) and accuracy (brier score = 0.13) were good in the developed model. In the temporal validation, discrimination (AUC = 0.80) and accuracy (brier score = 0.13) were good, and calibration was acceptable (slope = 1.19, intercept = 0.52). Conclusion: We developed prediction model for 90-day mortality after acute colorectal cancer surgery that may be a promising tool for surgeons to identify patients at risk of postoperative mortality.

KW - Acute surgery

KW - Colorectal cancer

KW - Emergency surgery

KW - Postoperative mortality

KW - Prediction model

U2 - 10.1007/s00384-021-03950-6

DO - 10.1007/s00384-021-03950-6

M3 - Journal article

C2 - 33982139

AN - SCOPUS:85105883040

VL - 36

SP - 1873

EP - 1883

JO - International Journal of Colorectal Disease

JF - International Journal of Colorectal Disease

SN - 0179-1958

IS - 9

ER -