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Vogelsang RP, Bojesen RD, Hoelmich ER, Orhan A, Buzquurz F, Cai L, Grube C, Zahid JA, Allakhverdiiev E, Raskov HH, Drakos I, Derian N, Ryan PB, Rijnbeek PR, Gögenur I. Prediction of 90-day mortality after surgery for colorectal cancer using standardized nationwide quality-assurance data. BJS Open 2021; 5:6272169. [PMID: 33963368 PMCID: PMC8105588 DOI: 10.1093/bjsopen/zrab023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background Personalized risk assessment provides opportunities for tailoring treatment, optimizing healthcare resources and improving outcome. The aim of this study was to develop a 90-day mortality-risk prediction model for identification of high- and low-risk patients undergoing surgery for colorectal cancer. Methods This was a nationwide cohort study using records from the Danish Colorectal Cancer Group database that included all patients undergoing surgery for colorectal cancer between 1 January 2004 and 31 December 2015. A least absolute shrinkage and selection operator logistic regression prediction model was developed using 121 pre- and intraoperative variables and internally validated in a hold-out test data set. The accuracy of the model was assessed in terms of discrimination and calibration. Results In total, 49 607 patients were registered in the database. After exclusion of 16 680 individuals, 32 927 patients were included in the analysis. Overall, 1754 (5.3 per cent) deaths were recorded. Targeting high-risk individuals, the model identified 5.5 per cent of all patients facing a risk of 90-day mortality exceeding 35 per cent, corresponding to a 6.7 times greater risk than the average population. Targeting low-risk individuals, the model identified 20.9 per cent of patients facing a risk less than 0.3 per cent, corresponding to a 17.7 times lower risk compared with the average population. The model exhibited discriminatory power with an area under the receiver operating characteristics curve of 85.3 per cent (95 per cent c.i. 83.6 to 87.0) and excellent calibration with a Brier score of 0.04 and 32 per cent average precision. Conclusion Pre- and intraoperative data, as captured in national health registries, can be used to predict 90-day mortality accurately after colorectal cancer surgery.
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Affiliation(s)
- R P Vogelsang
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - R D Bojesen
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - E R Hoelmich
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - A Orhan
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - F Buzquurz
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - L Cai
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - C Grube
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - J A Zahid
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - E Allakhverdiiev
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark.,Odysseus Data Services Inc., Cambridge, Massachusetts, USA
| | - H H Raskov
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - I Drakos
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - N Derian
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark
| | - P B Ryan
- Department of Medical Informatics, Janssen Research & Development LLC, Raritan, New Jersey, USA.,Columbia University, New York, New York, USA
| | - P R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - I Gögenur
- Center for Surgical Science, Department of Surgery, Zealand University Hospital, Koege, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Buzquurz F, Bojesen RD, Grube C, Madsen MT, Gögenur I. Impact of oral preoperative and perioperative immunonutrition on postoperative infection and mortality in patients undergoing cancer surgery: systematic review and meta-analysis with trial sequential analysis. BJS Open 2020; 4:764-775. [PMID: 32573977 PMCID: PMC7528521 DOI: 10.1002/bjs5.50314] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Infectious complications occur in 4–22 per cent of patients undergoing surgical resection of malignant solid tumours. Improving the patient's immune system in relation to oncological surgery with immunonutrition may play an important role in reducing postoperative infections. A meta‐analysis was undertaken to evaluate the potential clinical benefits of immunonutrition on postoperative infections and 30‐day mortality in patients undergoing oncological surgery. Methods PubMed, Embase and Cochrane Library databases were searched to identify eligible studies. Eligible studies had to include patients undergoing elective curative surgery for a solid malignant tumour and receiving immunonutrition orally before surgery, including patients who continued immunonutrition into the postoperative period. The main outcome was overall infectious complications; secondary outcomes were surgical‐site infection (SSI) and 30‐day mortality, described by relative risk (RR) with trial sequential analysis (TSA). Risk of bias was assessed according to Cochrane methodology. Results Some 22 RCTs with 2159 participants were eligible for meta‐analysis. Compared with the control group, immunonutrition reduced overall infectious complications (RR 0·58, 95 per cent c.i. 0·48 to 0·70; I2 = 7 per cent; TSA‐adjusted 95 per cent c.i. 0·28 to 1·21) and SSI (RR 0·65, 95 per cent c.i. 0·50 to 0·85; I2 = 0 per cent; TSA‐adjusted 95 per cent c.i. 0·21 to 2·04). Thirty‐day mortality was not altered by immunonutrition (RR 0·69, 0·33 to 1·40; I2 = 0 per cent). Conclusion Immunonutrition reduced overall infectious complications, even after controlling for random error, and also reduced SSI. The quality of evidence was moderate, and mortality was not affected by immunonutrition (low quality). Oral immunonutrition merits consideration as a means of reducing overall infectious complications after cancer surgery.
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Affiliation(s)
- F Buzquurz
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - R D Bojesen
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - C Grube
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.,Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - M T Madsen
- Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - I Gögenur
- Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
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