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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Validity of the CR-POSSUM model in surgery for colorectal cancer in Spain (CCR-CARESS study) and comparison with other models to predict operative mortality

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2018
Autoren:
Marisa Baré, Manuel Jesús Alcantara, Maria José Gil, Pablo Collera, Marina Pont, Antonio Escobar, Cristina Sarasqueta, Maximino Redondo, Eduardo Briones, Paula Dujovne, Jose Maria Quintana, on behalf of the CARESS-CCR Study Group
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-018-2839-x) contains supplementary material, which is available to authorized users.

Abstract

Background

To validate and recalibrate the CR- POSSUM model and compared its discriminatory capacity with other European models such as POSSUM, P-POSSUM, AFC or IRCS to predict operative mortality in surgery for colorectal cancer.

Methods

Prospective multicenter cohort study from 22 hospitals in Spain. We included patients undergoing planned or urgent surgery for primary invasive colorectal cancers between June 2010 and December 2012 (N = 2749). Clinical data were gathered through medical chart review. We validated and recalibrated the predictive models using logistic regression techniques. To calculate the discriminatory power of each model, we estimated the areas under the curve - AUC (95% CI). We also assessed the calibration of the models by applying the Hosmer-Lemeshow test.

Results

In-hospital mortality was 1.5% and 30-day mortality, 1.7%. In the validation process, the discriminatory power of the CR-POSSUM for predicting in-hospital mortality was 73.6%. However, in the recalibration process, the AUCs improved slightly: the CR-POSSUM reached 75.5% (95% CI: 67.3–83.7). The discriminatory power of the CR-POSSUM for predicting 30-day mortality was 74.2% (95% CI: 67.1–81.2) after recalibration; among the other models the POSSUM had the greatest discriminatory power, with an AUC of 77.0% (95% CI: 68.9–85.2). The Hosmer-Lemeshow test showed good fit for all the recalibrated models.

Conclusion

The CR-POSSUM and the other models showed moderate capacity to discriminate the risk of operative mortality in our context, where the actual operative mortality is low. Nevertheless the IRCS might better predict in-hospital mortality, with fewer variables, while the CR-POSSUM could be slightly better for predicting 30-day mortality.

Trail registration

Registered at: ClinicalTrials.gov Identifier: NCT02488161
Zusatzmaterial
Additional file 1: Appendix A. Equations for calculating risk of death for each predictive score. Appendix B. Univariate and bivariate analyses of POSSUM and P-POSSUM factors for operative mortality. Appendix C. Univariate and bivariate analyses of IRCS and AFC factors for operative mortality. Appendix D. Re-calibrated equations for calculating risk of in-hospital mortality for each predictive score. Appendix E. Re-calibrated equations for calculating risk of 30-day mortality for each predictive score. (DOCX 63 kb)
12913_2018_2839_MOESM1_ESM.docx
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