A Prediction Model for Severe Complications after Elective Colorectal Cancer Surgery in Patients of 70 Years and Older
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Data and Participants
2.2. Outcome
2.3. Predictors
2.4. Statistical Analysis
3. Results
3.1. Participants
3.2. Model Development
3.3. Clinical Prediction Model
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Total | (%) | Reintervention | ICU > 2 Days | LOS > 14 Days | 30-Day Mortality | |
---|---|---|---|---|---|---|
Reintervention | 100 | (9) | x | 26 | 58 | 10 |
ICU admission > 2 days | 51 | (5) | 26 | x | 29 | 6 |
Length of hospital stay (LOS) > 14 days | 124 | (11) | 58 | 29 | x | 1 |
30-day mortality | 19 | (2) | 10 | 6 | 1 | x |
1 or more severe complications (total) | 171 | (16) | 100 | 44 | 114 | 19 |
Patients (n = 1088) | Severe Complications (n = 171) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Predictor | Missing | (%) | No. | (SD/%) | Yes (%) | No. (%) | OR | (95% CI) | p-Value | ||
Individual Questions | |||||||||||
Katz ADL | |||||||||||
Dressing | 15 | (1) | 63 | (6) | 20 | (32) | 43 | (68) | 2.67 | (1.53–4.66) | 0.001 |
Bathing | 16 | (1) | 74 | (7) | 20 | (27) | 54 | (73) | 2.09 | (1.22–3.60) | 0.007 |
Incontinence | 20 | (2) | 96 | (9) | 23 | (24) | 73 | (76) | 1.77 | (1.07–2.92) | 0.026 |
Transfer | 17 | (2) | 19 | (2) | 11 | (58) | 8 | (42) | 7.6 | (2.10–27.49) | 0.002 |
Eating | 19 | (2) | 12 | (1) | 5 | (42) | 7 | (58) | 3.89 | (1.22–12.40) | 0.02 |
Toilet | 15 | (1) | 25 | (2) | 10 | (40) | 15 | (60) | 3.7 | (1.63–8.38) | 0.002 |
Previous delirium | 41 | (4) | 57 | (5) | 18 | (32) | 39 | (68) | 2.63 | (1.46–4.71) | 0.001 |
Self-reported cognitive impairment | 18 | (2) | 145 | (13) | 36 | (25) | 109 | (75) | 1.95 | (1.28–2.96) | 0.002 |
Need for ADL assistance | 29 | (3) | 80 | (7) | 24 | (30) | 56 | (70) | 2.47 | (1.48–4.10) | 0.001 |
Model Name | GerCRC | ACS-NSQIP Universal Model | CR-BHOM |
---|---|---|---|
Year | 2019 | 2013 [19] | 2011 [48] |
Population | CRC surgery (Mean age 77) | CR surgery (Mean age 61) | CRC surgery (Mean age 74) |
Definition Severe | Any complication leading to death, ICU admission >2 days, reintervention, or a hospital stay >14 days | Deep wound infection, wound disruption, CVA, MI, cardiac arrest, PE, ventilator dependence, AKI, major bleeding, sepsis | Anastomotic leakage, abscess, bleeding or bowel obstruction (not including mortality) |
Complications | |||
No. Predictors | 8 | 15 | 5 |
Predictors | Gender, COPD/asthma/emphysema, Previous PE or DVT, rectal cancer, mobility aid, previous delirium, need for ADL assistance, polypharmacy | Age, tumour stage, COPD, dyspnoea, BMI, functional dependency, creatinine, albumin, PT time, sepsis, operative urgency, disseminated cancer, indication for surgery, surgical extent, wound class | Age, urea, sodium, albumin, operative urgency |
Development AUC | 0.69 (0.65 #) | 0.72 | 0.70 |
External AUC | none | none | 0.66 * |
External calibration | none | none | Poor-fit * |
References
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No Patients = 1088 | Odds Ratio (95% CI) | |||||
---|---|---|---|---|---|---|
Missing | All | Severe Complication | ||||
Predictors | Yes | No | p–Value | |||
Demographics | ||||||
Age Years (mean and SD) | – | 77.67 (5.2) | 78.5 (5.2) | 77.51 (5.1) | 1.038 (1.01–1.07) | 0.017 |
Age Categories | ||||||
70–74 | – | 383 (35) | 47 (12) | 336 (88) | reference | |
75–79 | – | 353 (32) | 62 (18) | 291 (82) | 1.52 (1.01–2.30) | 0.044 |
80–84 | – | 241 (22) | 40 (17) | 201 (83) | 1.42 (0.90–2.25) | 0.13 |
85+ | – | 111 (10) | 22 (20) | 89 (80) | 1.77 (1.01–3.09) | 0.045 |
Gender | – | |||||
Females | – | 498 (46) | 60 (12) | 439 (88) | reference | |
Males | – | 590 (54) | 111 (19) | 479 (81) | 1.69 (1.2–2.38) | 0.002 |
BMI kg/m2 (mean and SD) | – | 26.48 (11.4) | 26.8 (4.4) | 26.4 (12.3) | 1 (0.99–1.01) | 0.71 |
BMI Categories | ||||||
<25 kg/m2 | – | 464 (43) | 62 (13) | 402 (87) | reference | |
25–30 kg/m2 | – | 467 (43) | 81 (17) | 386 (83) | 1.36 (0.95–1.95) | 0.09 |
>30 kg/m2 | – | 157 (14) | 28 (18) | 129 (82) | 1.41 (0.86–2.29) | 0.17 |
Comorbidity | ||||||
History of Abdominal Surgery | – | 460 (42) | 75 (16) | 385 (84) | 1.08 (0.78–1.50) | 0.65 |
Cardiac Comorbidity | – | 401 (37) | 74 (18) | 327 (82) | 1.38 (0.99–1.92) | 0.06 |
COPD/Asthma/Emphysema | – | 110 (10) | 30 (27) | 80 (73) | 2.27 (1.41–3.51) | 0.001 |
Previous PE or DVT a | – | 52 (5) | 15 (29) | 37 (71) | 2.56 (1.25–4.44) | 0.008 |
Charlson Comorbidity Index (median and range) | 1 (0–2) | 1 (0–8) | 1 (0–7) | 1.27 (1.03–1.56) | 0.022 | |
Comorbidity CCI ≥ 2 | – | 392 (36) | 76 (19) | 318 (81) | 1.49 (1.07–2.07) | 0.02 |
ASA Score (mean and SD) | 2.3 (0.6) | 2.4 (0.7) | 2.2 (0.6) | 1.61 (1.24–2.07) | <0.001 | |
I–II | – | 734 (67) | 97 (13) | 637 (87) | reference | |
III–IV | – | 354 (33) | 74 (21) | 280 (79) | 1.74 (1.24–2.42) | 0.001 |
Tumour Location | ||||||
Colon | – | 818 (75) | 120 (15) | 698 (85) | reference | |
Rectum | – | 270 (25) | 51 (19) | 219 (81) | 1.35 (0.94–1.94) | 0.099 |
Tumour Stage | ||||||
I | – | 336 (31) | 54 (16) | 282 (84) | reference | |
II | – | 411 (38) | 63 (15) | 348 (85) | 0.95 (0.64–1.04) | 0.78 |
III | – | 341 (31) | 54 (16) | 287 (84) | 0.98 (0.65–1.48) | 0.93 |
Surgical Approach | ||||||
Laparoscopic | – | 877 (81) | 119 (14) | 758 (86) | reference | |
Open | – | 211 (19) | 52 (25) | 159 (75) | 2.08 (1.44–3.01) | <0.001 |
Geriatric | ||||||
Katz ADL (mean and SD) | 15 | 0.3 (0.8) | 0.5 (1.3) | 0.2 (0.7) | 1.38 (1.18–1.61) | <0.001 |
score ≥2 | 65 (6) | 22 (34) | 43 (66) | 2.97 (1.73–5.11) | <0.001 | |
Reported Falls | 76 | 129 (12) | 24 (19) | 105 (81) | 1.19 (0.74–1.92) | 0.47 |
Risk for Malnutrition | 12 | 215 (20) | 37 (17) | 156 (73) | 1.35 (0.90–2.02) | 0.1 |
Risk for Delirium (mean and SD) | 18 | 0.3 (0.6) | 0.5 (0.8) | 0.2 (0.6) | 1.69 (1.34–2.12) | <0.001 |
Delirium Score ≥1 | 210 (19) | 56 (27) | 154 (73) | 2.38 (1.65–3.42) | <0.001 | |
Medication Use (mean and SD) | 18 | 4 (0–17) | 5 (0–17) | 4 (0–16) | 1.1 (1.05–1.56) | <0.001 |
Polypharmacy (No. ≥5) | 490 (45) | 103 (21) | 387 (79) | 2.18 (1.55–3.07) | <0.001 | |
Preoperative Use of a Mobility Aid | 21 | 191 (18) | 51 (27) | 116 (61) | 2.39 (1.64–3.47) | <0.001 |
Demographic Model | Geriatric Model | |
---|---|---|
Predictors | Beta a | Beta a |
Cohort model estimates | ||
Intercept | −6.64 | −2.64 |
Age (for every 10 years) | 0.14 | 0.04 |
Male gender | 0.26 | 0.32 |
BMI, kg/m2 | – | – |
History of abdominal surgery | – | – |
Cardiac comorbidity | – | – |
COPD/asthma/emphysema | 0.27 | 0.34 |
Previous PE or DVT b | 0.37 | 0.35 |
ASA score | 0.2 | 0.02 |
Rectal tumour | 0.03 | 0.12 |
Tumour stage | * | – |
Reported falls | * | – |
Risk for malnutrition | * | – |
Previous delirium | * | 0.33 |
Self-reported cognitive impairment | * | 0.09 |
Self-reported need for ADL assistance | * | 0.16 |
Mobility aid | * | 0.43 |
Polypharmacy (≥5) | * | 0.35 |
Model performance (AUC) | ||
Model after bootstrapping | 0.648 | 0.687 |
Optimism corrected model | 0.623 | 0.650 |
Characteristic | Score |
---|---|
Male gender | 2 |
COPD/asthma/emphysema | 2 |
Previous PE or DVT a | 2 |
Rectal cancer | 1 |
Mobility aid | 2 |
Previous delirium | 2 |
Need for ADL assistance | 1 |
Polypharmacy | 2 |
Total Score (add all) | |
Probability of developing a severe complication (Table 3) | % |
Score from Table 3 | Events/No. Cases | Predicted | Sensitivity a | Specificity a | +LR b | −LR b |
---|---|---|---|---|---|---|
0–1 | 18/217 | 10% | 1 | 0 | 1 | - |
2 | 28/293 | 13% | 0.89 | 0.22 | 1.14 | 0.49 |
3 | 20/139 | 14% | 0.73 | 0.51 | 1.48 | 0.53 |
4 | 37/198 | 17% | 0.61 | 0.64 | 1.69 | 0.61 |
5 | 11/86 | 19% | 0.40 | 0.81 | 2.11 | 0.74 |
6 | 23/80 | 23% | 0.33 | 0.89 | 3.12 | 0.75 |
7-or higher | 34/75 | 31% | 0.20 | 0.96 | 4.45 | 0.84 |
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Souwer, E.T.D.; Bastiaannet, E.; Steyerberg, E.W.; Dekker, J.W.T.; Steup, W.H.; Hamaker, M.M.; Sonneveld, D.J.A.; Burghgraef, T.A.; van den Bos, F.; Portielje, J.E.A. A Prediction Model for Severe Complications after Elective Colorectal Cancer Surgery in Patients of 70 Years and Older. Cancers 2021, 13, 3110. https://doi.org/10.3390/cancers13133110
Souwer ETD, Bastiaannet E, Steyerberg EW, Dekker JWT, Steup WH, Hamaker MM, Sonneveld DJA, Burghgraef TA, van den Bos F, Portielje JEA. A Prediction Model for Severe Complications after Elective Colorectal Cancer Surgery in Patients of 70 Years and Older. Cancers. 2021; 13(13):3110. https://doi.org/10.3390/cancers13133110
Chicago/Turabian StyleSouwer, Esteban T. D., Esther Bastiaannet, Ewout W. Steyerberg, Jan Willem T. Dekker, Willem H. Steup, Marije M. Hamaker, Dirk J. A. Sonneveld, Thijs A. Burghgraef, Frederiek van den Bos, and Johanna E. A. Portielje. 2021. "A Prediction Model for Severe Complications after Elective Colorectal Cancer Surgery in Patients of 70 Years and Older" Cancers 13, no. 13: 3110. https://doi.org/10.3390/cancers13133110