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30-day mortality after elective colorectal surgery can reasonably be predicted

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Abstract

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.

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Authors and Affiliations

  1. Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA

    A. C. Murray, J. Rein & R. P. Kiran

  2. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA

    C. Mauro & R. P. Kiran

Authors
  1. A. C. Murray
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  2. C. Mauro
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  3. J. Rein
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  4. R. P. Kiran
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Correspondence to R. P. Kiran.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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Murray, A.C., Mauro, C., Rein, J. et al. 30-day mortality after elective colorectal surgery can reasonably be predicted. Tech Coloproctol 20, 567–576 (2016). https://doi.org/10.1007/s10151-016-1503-x

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  • DOI: https://doi.org/10.1007/s10151-016-1503-x

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