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A model predicting operative mortality in the UK has only limited value in Denmark

International Journal of Colorectal Disease volume 33, pages 141–147 (2018)Cite this article

Abstract

Purpose

Postoperative mortality from colorectal cancer varies between surgical departments. Several models have been developed to predict the operative risk. This study aims to investigate whether the original and the revised Association of Coloproctology of Great Britain and Ireland (ACPGBI) model can predict 30-day mortality after colorectal cancer surgery in Denmark.

Methods

Data were collected from the Danish Colorectal Cancer Group database which has > 95% completeness. All patients operated on from January 2007 to December 2013 were included. The individual estimated operative risk was calculated with the original and revised ACPGBI models. Discrimination and calibration were evaluated with a Receiver Operating Characteristic (ROC) curve analysis and a Hosmer-Lemeshow test, respectively.

Results

In total, 22,807 patients underwent open or laparoscopic colorectal cancer surgery. After excluding 1437 patients because of missing data, 21,370 patients were left for the analyses. The observed 30-day mortality was 5.0%. The original and revised ACPGBI models estimated an operative risk of 7.0 and 4.0%, respectively, with a significant difference in observed and estimated mortality in both models. However, in patients with an estimated risk of at least 26%, i.e., high-risk, good calibration was found with the original ACPGBI model. Discrimination was good with an AUC of 0.83 (95% CI 0.82–0.84) in both models.

Conclusion

The original and revised ACPGBI models are not suitable prediction models for postoperative mortality in the Danish colorectal cancer population. However, the original model might be applicable in predicting mortality in high-risk patients.

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Funding

The study was supported by grants from the Danish Council of Independent Research/Medical Science.

One co-author, Lene H. Iversen, has received funding from the Danish Council for Independent Research in 2014. No other financial support has been received from external sources.

Author information

Authors and Affiliations

  1. Centre for Surgical Science (CSS), Zealand University Hospital, Lykkebækvej 1, 4600, Køge, Denmark

    Thea Helene Degett & Ismail Gögenur

  2. Department of Surgery, Zealand University Hospital, Roskilde, Denmark

    Ole Roikjær

  3. Department of Surgery, Section of Coloproctology, Aarhus University Hospital, Aarhus, Denmark

    Lene Hjerrild Iversen

  4. Danish Colorectal Cancer Group, Copenhagen, Denmark

    Ole Roikjær, Lene Hjerrild Iversen & Ismail Gögenur

Authors
  1. Thea Helene Degett
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  2. Ole Roikjær
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Contributions

Thea Helene Degett, Ole Roikjær, Lene Hjerrild Iversen, Ismail Gögenur; design

Ole Roikjær; statistics

Thea Helene Degett; manuscript writing

Thea Helene Degett, Ole Roikjær, Lene Hjerrild Iversen, Ismail Gögenur; manuscript reviewing

Thea Helene Degett, Ole Roikjær, Lene Hjerrild Iversen, Ismail Gögenur; final approval

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Correspondence to Thea Helene Degett.

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Degett, T.H., Roikjær, O., Iversen, L.H. et al. A model predicting operative mortality in the UK has only limited value in Denmark. Int J Colorectal Dis 33, 141–147 (2018). https://doi.org/10.1007/s00384-017-2937-y

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  • DOI: https://doi.org/10.1007/s00384-017-2937-y

Keywords

  • Calibration
  • Colorectal cancer
  • Study population
  • Prediction model
  • ACPGBI
  • 30-day mortality