Operative mortality in colorectal cancer: prospective national study
Operative mortality in colorectal cancer: prospective national study
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DOI：
10.1136/bmj.327.7425.1196
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发表时间：
2003-11-22
影响因子：
105.7
通讯作者：
Stamatakis, JD
中科院分区：
文献类型：
--
作者：
Tekkis, PP;Poloniecki, JD;Stamatakis, JD
目的建立一个预测结直肠癌术后死亡概率的数学模型，设计描述性研究，使用常规收集的临床资料，数据来源英国和爱尔兰结肠直肠病学协会（ACPGBI）数据库，包括73家医院在12个月期间新诊断的8077例结直肠癌患者。Logistic回归模型用于确定手术死亡率的独立预测因素。结果术后总死亡率为7.5%（95%可信区间6.9%~ 8.1%）。死亡的独立预测因素是年龄、美国麻醉学会（阿萨）分级、Dukes分期、手术紧急程度和癌症切除。当测试的预测模型表现出良好的歧视（在受试者工作特征曲线下的面积= 0.775）和校准（观察到的与预期的死亡率在不同的程序之间的比较; Hosmer-Lemeshow统计= 6.34，8 df，P = 0.610）。结论临床医生可以预测术后死亡，通过使用一个简单的数字表来自ACPGBI的统计模型。该模型可用于患者及其护理人员的术前咨询的日常实践中，作为多学科护理的一部分。它也可用于比较结直肠癌多学科团队之间的结果。
Objective To develop a mathematical model that will predict the probability of death after surgery for colorectal cancer.Design Descriptive study using routinely collected clinical data.Data source The database of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), encompassing 8077 patients with a new diagnosis of colorectal cancer in 73 hospitals during a 12 month period.Statistical analysis A three level hierarchical logistic regression model was used to identify independent predictors of operative mortality. The model was developed on 60% of the patient population and its validity tested on the remaining 40%.Results Overall postoperative mortality was 7.5% (95% confidence interval 6.9% to 8.1%). Independent predictors of death were age, American Society of Anesthesiology (ASA) grade, Dukes's stage, urgency of the operation, and cancer excision. When tested the predictive model showed good discrimination (area under the receiver operating characteristic curve = (0.775) and calibration (comparison of observed with expected mortality across different procedures; Hosmer-Lemeshow statistic = 6.34, 8 df, P = 0.610).Conclusions Clinicians can predict postoperative death by using a simple numerical table derived from the statistical model of the ACPGBI. The model can be used in everyday practice for preoperative counselling of patients and their carers as a part of multidisciplinary care. It may also be used to compare the outcomes between multidisciplinary teams for colorectal cancer.