Improved Preoperative Risk Assessment Tools Are Needed to Guide Informed Decision Making before Esophagectomy

Gray, KD; Nobel, TB; Hsu, M; Tan, KS; Chudgar, N; Yan, S; Rusch, VW; Jones, DR; Rocco, G; Molena, D; Isbell, JM

doi:10.1097/sla.0000000000004715

Perioperative medicine & outcomes

Improved Preoperative Risk Assessment Tools Are Needed to Guide Informed Decision Making before Esophagectomy

Ann SurgPublished 18 Dec 2020Prognostic accuracy study

Read the original article ↗PubMed

Cite

Authors' conclusion

SRC and frailty index did not adequately predict complications after esophagectomy.

Study context

Population: Patients undergoing open or minimally invasive esophagectomy, January 2016–June 2018
Participants: 240 consecutive patients

Comparison: ACS NSQIP Surgical Risk Calculator (SRC) and 5-factor NSQIP-derived frailty index for predicting postoperative morbidity
Outcome: Performance in predicting postoperative morbidity (C-index and calibration curves)

Methodological detailsretrospective analysis of a prospectively maintained database, consecutive patients, single-institution database, 85% underwent Ivor Lewis esophagectomy

Retrospective analysis of a prospectively maintained database
Consecutive patients
Single-institution database
85% underwent Ivor Lewis esophagectomy

Performance

As reported in the abstract

Discrimination of complications (C-index)

Test or model	Value	Concordance index (C-index), open esophagectomy	C-index, minimally invasive esophagectomy	C-index, serious complication	C-index, readmission
SRC	C-index 0.553	0.569	0.542
Frailty index	C-index 0.513			0.523	0.559

Value

SRCC-index 0.553

Frailty indexC-index 0.513

Concordance index (C-index), open esophagectomy

SRC0.569

Frailty index—

C-index, minimally invasive esophagectomy

SRC0.542

Frailty index—

C-index, serious complication

SRC—

Frailty index0.523

C-index, readmission

SRC—

Frailty index0.559

Further findings

Observed complication rates

Overall complication rate: 39%
Serious complication rate: 33%

SRC discrimination for specific outcomes (C-index)

Reoperation (lowest): 0.533
Discharge to a facility other than home (highest): 0.728

Original publication

Improved Preoperative Risk Assessment Tools Are Needed to Guide Informed Decision Making before Esophagectomy. Ann Surg. Published 18 December 2020. doi:10.1097/sla.0000000000004715

Read the original article ↗

Composed by AI from the published abstract and checked against it. How Briefs are made →