Preoperative Nomogram to Predict Risk of Perioperative Mortality Following Pancreatic Resections for Malignancy
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The majority of pancreatic resections for malignancy are performed in older patients with major comorbidities. The aim of this study was to develop a preoperative nomogram based on the presence of comorbidities to predict risk of perioperative mortality.
Materials and Methods
The National Inpatient Sample database was queried to identify patients that underwent pancreatectomy for malignancy. The preoperative comorbidities identified as predictors were used, and a nomogram was created. Sample A (2000–2004) was utilized to develop the model, and sample B (2005) was utilized to validate this model.
The overall actual observed perioperative mortality rate for samples A and B was 6.3% and 5.2%, respectively. The mean total points calculated for sample A by the nomogram was 131.7 that translates to a nomogram-predicted mortality rate of 4.9%, which is similar to the actual mortality. The mean total points for sample B was 128.1, which translates to a nomogram-predicted mortality rate of 4.6%. The similarity of mortality rates as predicted by the nomogram and a concordance index of 0.76 shows good agreement between the data and the nomogram.
This preoperative nomogram has been shown to accurately predict the risk of perioperative mortality following pancreatectomy for malignancy.
- http://www.cancer.org/downloads/STT/Cancer_Statistics_2008.ppt—accessed March 2009.
- http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf—accessed March 2009.
- Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 2006;10:1199–1210. CrossRef
- Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244:10–15. CrossRef
- Vin Y, Sima CS, Getrajdman GI, Brown KT, Covey A, Brennan MF, Allen PJ. Management and outcomes of postpancreatectomy fistula, leak and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg 2008;207:490–498. CrossRef
- McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF. Perioperative mortality for pancreatectomy. A national perspective. Ann Surg 2007;246:246–253. CrossRef
- Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27. CrossRef
- Research Triangle Institute. SUDAAN Language Manual, Release 10.0 Research Triangle Park. 2008.
- Iasonos A, Schrag D, Raj GV, Panageas KS. How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 2008;26:1364–1370. CrossRef
- Brittain E. Probability of coronary heart disease developing. West J Med 1982;136:86–89.
- Asiyanbola B, Chang D, Gleisner AL, Nathan H, Choti MA, Schulick RD, Pawlik TM. Operative mortality after hepatic resection: are literature-based rates broadly applicable? J Gastrointest Surg 2008;12:842–851. CrossRef
- Sohn TA, Yeo CJ, Cameron JL, Lillemoe KD, Talamini MA, Hruban RH, Sauter PK, Coleman J, Ord SE, Grochow LB, Abrams RA, Pitt HA. Should pancreaticoduodenectomy be performed in octogenarians? J Gastrointest Surg 1998;2:207–216. CrossRef
- Makary MA, Winter JM, Cameron JL, Campbell KA, Chang D, Cunningham SC, Riall TS, Yeo CJ. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 2006;10:347–356. CrossRef
- Riall TS, Reddy DM, Nealon WH, Goodwin JS. The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 2008;248:459–467.
- Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222:638–645. CrossRef
- Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long term survival is superior after resection for cancers in high-volume centers. Ann Surg 2005;242:540–544.
- Meguid RA, Ahuja N, Chang DC. What constitutes a “high-volume” hospital for pancreatic resection? J Am Coll Surg 2008;206:622. CrossRef
- Riall TS, Nealon WH, Goodwin JS, Townsend CM Jr, Freeman JL. Outcomes following pancreatic resection: variability among high-volume providers. Surgery 2008;144:133–140. CrossRef
- Eastham JA, Kattan MW, Scardino PT. Nomograms as predictive models. Semin Urol Oncol 2002;20:108–115. CrossRef
- Kattan MW. Comparison of Cox regression with other methods for determining prediction models and nomograms. J Urol 2003;170:S6–S9. CrossRef
- Kattan MW, Leung DH, Brennan MF. Postoperative nomogram for 12-year sarcoma-specific death. J Clin Oncol 2002;20:791–796. CrossRef
- Kattan MW, Karpeh MS, Mazumdar M, Brennan MF. Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. J Clin Oncol 2003;21:3647–3650. CrossRef
- Brennan MF, Kattan MW, Klimstra D, Conlon K. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg 2004;240:293–298. CrossRef
- Lin KY, Johns FR, Gibson J, Long M, Drake DB, Moore MM. An outcome study of breast reconstruction: presurgical identification of risk factors for complications. Ann Surg Oncol 2001;8:586–591. CrossRef
- Lagarde SM, Reitsma JB, Maris AD, van Berge Henegouwen MI, Busch OR, Obertop H, Zwinderman AH, van Lanschot JJ. Preoperative prediction of the occurrence and severity of complications after esophagectomy for cancer with use of a nomogram. Ann Thorac Surg 2008;85:1938–1946. CrossRef
- Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996;15:361–387. CrossRef
- Wong SL, Kattan MW, McMaster KM, Coit DG. A nomogram that predicts the presence of sentinel node metastasis in melanoma with better discrimination than the American Joint Committee on Cancer staging system. Ann Surg Onc 2005;12:282–288. CrossRef
- Preoperative Nomogram to Predict Risk of Perioperative Mortality Following Pancreatic Resections for Malignancy
Journal of Gastrointestinal Surgery
Volume 13, Issue 12 , pp 2152-2162
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- 1. Division of Surgical Oncology, Department of Surgery, Eppley Cancer Center, University of Nebraska Medical Centre, Omaha, NE, USA
- 5. Division of Surgical Oncology, Department of Surgery/Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, 68198, USA
- 2. University of Nebraska College of Medicine, Omaha, NE, USA
- 3. Department of Pathology, University of Nebraska Medical Center, Omaha, NE, USA
- 4. Department of Biostatistics, College of Public Health, University of Nebraska Medical Centre, Omaha, NE, USA