Improved Preoperative Risk Assessment Tools Are Needed to Guide Informed Decision Making before Esophagectomy.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 Jan 2023
01 Jan 2023
Historique:
pmc-release:
01
01
2024
pubmed:
23
12
2020
medline:
3
3
2023
entrez:
22
12
2020
Statut:
ppublish
Résumé
We sought to evaluate the performance of 2 commonly used prediction models for postoperative morbidity in patients undergoing open and minimally invasive esophagectomy. Patients undergoing esophagectomy have a high risk of postoperative complications. Accurate risk assessment in this cohort is important for informed decision-making. We identified patients who underwent esophagectomy between January 2016 and June 2018 from our prospectively maintained database. Predicted morbidity was calculated using the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (SRC) and a 5-factor National Surgical Quality Improvement Programderived frailty index. Performance was evaluated using concordance index (C-index) and calibration curves. In total, 240 consecutive patients were included for analysis. Most patients (85%) underwent Ivor Lewis esophagectomy. The observed overall complication rate was 39%; the observed serious complication rate was 33%.The SRC did not identify risk of complications in the entire cohort (C-index, 0.553), patients undergoing open esophagectomy (C-index, 0.569), or patients undergoing minimally invasive esophagectomy (C-index, 0.542); calibration curves showed general underestimation. Discrimination of the SRC was lowest for reoperation (C-index, 0.533) and highest for discharge to a facility other than home (C-index, 0.728). Similarly, the frailty index had C-index of 0.513 for discriminating any complication, 0.523 for serious complication, and 0.559 for readmission. SRC and frailty index did not adequately predict complications after esophagectomy. Procedure-specific risk-assessment tools are needed to guide shared patient-physician decision-making in this high-risk population.
Sections du résumé
OBJECTIVE
OBJECTIVE
We sought to evaluate the performance of 2 commonly used prediction models for postoperative morbidity in patients undergoing open and minimally invasive esophagectomy.
SUMMARY BACKGROUND DATA
BACKGROUND
Patients undergoing esophagectomy have a high risk of postoperative complications. Accurate risk assessment in this cohort is important for informed decision-making.
METHODS
METHODS
We identified patients who underwent esophagectomy between January 2016 and June 2018 from our prospectively maintained database. Predicted morbidity was calculated using the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (SRC) and a 5-factor National Surgical Quality Improvement Programderived frailty index. Performance was evaluated using concordance index (C-index) and calibration curves.
RESULTS
RESULTS
In total, 240 consecutive patients were included for analysis. Most patients (85%) underwent Ivor Lewis esophagectomy. The observed overall complication rate was 39%; the observed serious complication rate was 33%.The SRC did not identify risk of complications in the entire cohort (C-index, 0.553), patients undergoing open esophagectomy (C-index, 0.569), or patients undergoing minimally invasive esophagectomy (C-index, 0.542); calibration curves showed general underestimation. Discrimination of the SRC was lowest for reoperation (C-index, 0.533) and highest for discharge to a facility other than home (C-index, 0.728). Similarly, the frailty index had C-index of 0.513 for discriminating any complication, 0.523 for serious complication, and 0.559 for readmission.
CONCLUSIONS
CONCLUSIONS
SRC and frailty index did not adequately predict complications after esophagectomy. Procedure-specific risk-assessment tools are needed to guide shared patient-physician decision-making in this high-risk population.
Identifiants
pubmed: 33351463
doi: 10.1097/SLA.0000000000004715
pii: 00000658-900000000-93843
pmc: PMC8211904
mid: NIHMS1696153
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
116-120Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Valerie W. Rusch reports grant support (institutional) from Genelux and Genentech, travel support from Intuitive Surgical, and travel support and payments from NIH/Coordinating Center for Clinical Trials. David R. Jones serves as a senior medical advisor for Diffusion Pharmaceuticals and a consultant for AstraZeneca and Merck. Gaetano Rocco has a financial relationship with Scanlan. Daniela Molena is a consultant for Intuitive Surgical, Johnson and Johnson, Urogen, and Boston Scientific. James M. Isbell has stock ownership in LumaCyte and is a consultant/advisory board member for Roche Genentech. All other authors report no conflicts of interest.
Références
Ann Surg. 2014 Nov;260(5):764-70; discussion 770-1
pubmed: 25379847
Ann Surg Oncol. 2008 Jun;15(6):1577-84
pubmed: 18379852
Circulation. 1999 Sep 7;100(10):1043-9
pubmed: 10477528
Medicine (Baltimore). 2016 Feb;95(7):e2724
pubmed: 26886613
Psychooncology. 2006 Jan;15(1):9-19
pubmed: 15669023
Ann Surg Oncol. 2011 Dec;18 Suppl 3:S295; author reply S296
pubmed: 21063789
JAMA. 1999 Dec 22-29;282(24):2313-20
pubmed: 10612318
Ann Thorac Surg. 2016 Jul;102(1):207-14
pubmed: 27240449
J Thorac Cardiovasc Surg. 2006 Sep;132(3):549-55
pubmed: 16935109
J Am Coll Surg. 2018 Feb;226(2):173-181.e8
pubmed: 29155268
Ann Surg. 2019 Feb;269(2):291-298
pubmed: 29206677
J Surg Res. 2017 Jul;215:28-33
pubmed: 28688658
Ann Surg. 2017 May;265(5):978-986
pubmed: 27232260
JAMA Surg. 2018 Feb 1;153(2):160-168
pubmed: 29049457
N Engl J Med. 2012 May 31;366(22):2074-84
pubmed: 22646630
Anesthesiology. 2013 Oct;119(4):959-81
pubmed: 24195875
JAMA. 2010 Mar 24;303(12):1190-1
pubmed: 20332406
J Surg Res. 2013 Jul;183(1):104-10
pubmed: 23415494
J Thorac Cardiovasc Surg. 2016 Mar;151(3):697-705.e1
pubmed: 26410001
JAMA Netw Open. 2018 Jun 1;1(2):e180281
pubmed: 30646073
J Gastrointest Surg. 2014 Aug;18(8):1532-42
pubmed: 24760219
J Am Coll Surg. 2013 Nov;217(5):833-42.e1-3
pubmed: 24055383
J Surg Oncol. 2020 Feb;121(2):313-321
pubmed: 31823377
Ann Thorac Surg. 2003 Jan;75(1):217-22; discussion 222
pubmed: 12537219
N Engl J Med. 2013 Oct 10;369(15):1434-42
pubmed: 24106936
Ann Surg Oncol. 2014 Jan;21(1):5-7
pubmed: 24197763
Cochrane Database Syst Rev. 2014 Jan 28;(1):CD001431
pubmed: 24470076
Expert Rev Gastroenterol Hepatol. 2012 Feb;6(1):115-22
pubmed: 22149587
J Arthroplasty. 2015 Sep;30(9 Suppl):5-10
pubmed: 26165953
Dis Esophagus. 2017 Jan 1;30(1):1-8
pubmed: 26730436
Ann Surg. 2009 Nov;250(5):798-807
pubmed: 19809297
Ann Surg Oncol. 2010 Sep;17(9):2274-82
pubmed: 20585875
J Surg Oncol. 2004 Nov 1;88(2):71-7
pubmed: 15499604
Epidemiology. 2010 Jan;21(1):128-38
pubmed: 20010215
J Am Coll Surg. 2016 Aug;223(2):231-9
pubmed: 27212006
N Engl J Med. 2002 Apr 11;346(15):1128-37
pubmed: 11948273