TY - JOUR
T1 - Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy
T2 - A novel scoring system
AU - Venkat, Raghunandan
AU - Puhan, Milo A.
AU - Schulick, Richard D.
AU - Cameron, John L.
AU - Eckhauser, Frederic E.
AU - Choti, Michael A.
AU - Makary, Martin A.
AU - Pawlik, Timothy M.
AU - Ahuja, Nita
AU - Edil, Barish H.
AU - Wolfgang, Christopher L.
PY - 2011/11
Y1 - 2011/11
N2 - Objective: To develop and validate a risk score to predict the 30- and 90-day mortality after a pancreaticoduodenectomy or total pancreatectomy on the basis of preoperative risk factors in a high-volume program. Design: Datafroma prospectively maintained institutional database were collected. In a random subset of 70% of patients (training cohort), multivariate logistic regression was used to develop a simple integer score, which was then validated in the remaining 30% of patients (validation cohort). Discrimination and calibration of the score were evaluated using area under the receiver operating characteristic curve and Hosmer-Lemeshow test, respectively. Setting: Tertiary referral center. Patients: The study comprised 1976 patients in a prospectively maintained institutional database who underwent pancreaticoduodenectomy or total pancreatectomy between 1998 and 2009. Main Outcome Measures: The 30- and 90-day mortality. Results: In the training cohort, age, male sex, preoperative serum albumin level, tumor size, total pancreatectomy, and a high Charlson index predicted 90-day mortality (area under the curve, 0.78; 95% CI, 0.71-0.85), whereas all these factors except Charlson index also predicted 30-day mortality (0.79; 0.68-0.89). On validation, the predicted and observed risks were not significantly different for 30-day (1.4% vs 1.0%; P=.62) and 90-day (3.8% vs 3.4%; P=.87) mortality. Both scores maintained good discrimination (for 30-day mortality, area under the curve, 0.74; 95% CI, 0.54-0.95; and for 90-day mortality, 0.73; 0.62-0.84). Conclusions: The risk scores accurately predicted 30- and 90-day mortality after pancreatectomy. They may help identify and counsel high-risk patients, support and calculate net benefits of therapeutic decisions, and control for selection bias in observational studies as propensity scores.
AB - Objective: To develop and validate a risk score to predict the 30- and 90-day mortality after a pancreaticoduodenectomy or total pancreatectomy on the basis of preoperative risk factors in a high-volume program. Design: Datafroma prospectively maintained institutional database were collected. In a random subset of 70% of patients (training cohort), multivariate logistic regression was used to develop a simple integer score, which was then validated in the remaining 30% of patients (validation cohort). Discrimination and calibration of the score were evaluated using area under the receiver operating characteristic curve and Hosmer-Lemeshow test, respectively. Setting: Tertiary referral center. Patients: The study comprised 1976 patients in a prospectively maintained institutional database who underwent pancreaticoduodenectomy or total pancreatectomy between 1998 and 2009. Main Outcome Measures: The 30- and 90-day mortality. Results: In the training cohort, age, male sex, preoperative serum albumin level, tumor size, total pancreatectomy, and a high Charlson index predicted 90-day mortality (area under the curve, 0.78; 95% CI, 0.71-0.85), whereas all these factors except Charlson index also predicted 30-day mortality (0.79; 0.68-0.89). On validation, the predicted and observed risks were not significantly different for 30-day (1.4% vs 1.0%; P=.62) and 90-day (3.8% vs 3.4%; P=.87) mortality. Both scores maintained good discrimination (for 30-day mortality, area under the curve, 0.74; 95% CI, 0.54-0.95; and for 90-day mortality, 0.73; 0.62-0.84). Conclusions: The risk scores accurately predicted 30- and 90-day mortality after pancreatectomy. They may help identify and counsel high-risk patients, support and calculate net benefits of therapeutic decisions, and control for selection bias in observational studies as propensity scores.
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U2 - 10.1001/archsurg.2011.294
DO - 10.1001/archsurg.2011.294
M3 - Article
C2 - 22106320
AN - SCOPUS:81855206223
SN - 0004-0010
VL - 146
SP - 1277
EP - 1284
JO - Archives of surgery
JF - Archives of surgery
IS - 11
ER -