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Erschienen in:
15.07.2016 | Original Article
30-day mortality after elective colorectal surgery can reasonably be predicted
Erschienen in: Techniques in Coloproctology | Ausgabe 8/2016
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Background
The aim of the present study was to develop a clinically relevant, accurate and usable risk assessment scoring system solely for colorectal cancer patients undergoing elective resection.
Methods
All colorectal resections for colorectal cancer 2006–2012 were identified from the American College of Surgeons Quality Improvement Program. Independent risk factors for 30-day mortality after elective surgery were identified using univariable and multivariable logistic regression. A points-calculator based on factors most strongly associated with mortality and accurately predicting risk of mortality was developed.
Results
Fifty-nine thousand nine hundred eighty-six patients underwent elective colorectal cancer surgery, and 1096 (1.8 %) died within 30 days. On multivariable analysis, the strongest risk factors for mortality were age ≥65 years [odds ratio (OR) 2.17, 95 % confidence interval (CI) 1.61–2.92], American Society of Anesthesiologists score ≥3 (OR 1.77, 95 % CI 1.29–2.42), renal failure (OR 3.15, 95 % CI 1.01–9.77), disseminated cancer (OR 2.56, 95 % CI 1.96–3.35), hypoalbuminemia (OR 2.84, 95 % CI 2.21–3.65), preoperative ascites (OR 3.17, 95 % CI 2.07–4.87), heart failure (OR 2.08, 95 % CI 1.35–3.20) and functional status (OR 2.05, 95 % CI 1.56–2.70). A model that accurately predicted risk of mortality was created using forward stepwise logistic regression and externally validated (area under the curve 0.826). This allowed for development of an eight-factor predictive score; maximum points conferred mortality of 96.1 % (p < 0.0001).
Conclusions
A simple preoperative scoring system predicting 30-day mortality with good capability may allow better preoperative risk assessment, optimization and decision-making.