Comparison of common risk stratification indices to predict outcomes among stage IV cancer patients with bowel obstruction undergoing surgery

Journal of Surgical Oncology - Tập 117 Số 3 - Trang 479-487 - 2018
Sarah B. Bateni1, Richard J. Bold1, Frederick J. Meyers2, Daniel Canter3, Robert J. Canter1
1Divison of Surgical Oncology, Department of Surgery, University of California, Davis Medical Center, Sacramento, California
2Division of Hematology/Oncology, Department of Internal Medicine, University of California, Davis Medical Center, Sacramento, California
3Department of Urology, Ochsner Clinic, New Orleans, Louisiana

Tóm tắt

Background and ObjectivesAmong patients with disseminated malignancy (DMa), bowel obstruction is common with high operative morbidity. Since preoperative risk stratification is critical, we sought to compare three standard risk indices, the American Society of Anesthesiology (ASA) classification, Charlson comorbidity index (CCI), and modified frailty index (mFI).MethodsWe identified 1928 DMa patients with bowel obstruction who underwent an abdominal operation from 2007 to 2012 American College of Surgeons National Surgical Quality Improvement Program. Multivariate analyses assessed predictors of prolonged length of stay (LOS), 30‐day serious morbidity and mortality. Receiver operating characteristics’ areas under the curves (AUCs) for risk indices scores and 30‐day mortality were assessed.ResultsSerious morbidity and mortality rates were 20.4% and 14.8%. ASA and CCI did not predict serious morbidity or prolonged LOS, but were predictors of mortality. The mFI did not predict prolonged LOS, but did predict serious morbidity and mortality. Subgroup analyses showed similar results. There were no significant differences between ASA, CCI, and mFI AUCs for mortality.ConclusionsASA, CCI, and mFI are limited in their ability to predict postoperative adverse events among DMa patients undergoing surgery for bowel obstruction. These data suggest that a more tailored preoperative risk stratification tool would improve treatment planning.

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Tài liệu tham khảo

10.1001/jamasurg.2013.4059

Lilley EJ, 2017, Survival, healthcare utilization, and end‐of‐life care among older adults with malignancy‐associated bowel obstruction: comparative study of surgery, venting gastrostomy, or medical management, Ann Surg

10.1016/0021-9681(87)90171-8

10.1016/j.surg.2016.04.013

10.1213/ANE.0000000000000187

10.1016/j.surg.2016.07.010

10.1097/TA.0b013e31824d0f70

10.1016/j.amjsurg.2015.09.015

10.1016/j.jamcollsurg.2015.08.428

10.1503/cmaj.050051

10.1016/j.jamcollsurg.2009.09.031

American College of Surgeons: User Guide for the 2012 ACS NSQIP Participan Use Data File. In 2013.

10.2106/JBJS.N.00041

10.1016/j.jvs.2011.05.116

10.1016/S0895-4356(96)00271-5

10.1371/journal.pone.0165315

10.1097/01.sla.0000133083.54934.ae

10.1097/SLA.0b013e3181b6b04c

10.1016/j.jamcollsurg.2015.01.053

10.1093/gerona/56.3.M146

10.1097/SLA.0b013e3181b45598

10.1016/j.jamcollsurg.2015.12.020

10.1177/0310057X1404200511

10.1093/bja/aeu100

10.1016/j.surg.2012.07.009

10.1097/SLA.0b013e31822513ed

10.1089/jpm.2015.0482

10.1002/cncr.29297

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Journal of Surgical Oncology

Tập 117 Số 3

479-487

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