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Multicenter Study
, 95 (10), e2999

Assessment of the Addition of Hypoalbuminemia to ACS-NSQIP Surgical Risk Calculator in Colorectal Cancer

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Multicenter Study

Assessment of the Addition of Hypoalbuminemia to ACS-NSQIP Surgical Risk Calculator in Colorectal Cancer

Wan-Hsiang Hu et al. Medicine (Baltimore).

Abstract

The aim of this study was to evaluate the benefit of adding hypoalbuminemia to the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Surgical Risk Calculator when predicting postoperative outcomes in colorectal cancer patients.The ACS-NSQIP Surgical Risk Calculator offers qualified risk evaluation in surgical decision-making and informed patient consent. To date, malnutrition defined as hypoalbuminemia, an important independent surgical risk factor in colorectal cancer, is not included.This is a retrospective, multi-institutional study of ACS-NSQIP patients (n = 18,532) who received colorectal surgery from 2009 to 2012. Models were constructed for predicting postoperative mortality and morbidity using the risk factors of the ACS-NSQIP Surgical Risk Calculator before and after adding hypoalbuminemia as a risk factor. The 2 models' performance was then compared using c-statistics and Brier scores. The ACS-NSQIP database in 2008 was used for validation of the created models.The prevalence of hypoalbuminemia (27.8%) is higher in colorectal cancer, when compared with other most common cancers. In univariate analyses, hypoalbuminemia was significantly associated with postoperative mortality and morbidity in colorectal cancer patients. In multivariate logistic regression analyses, 15 postoperative complications, including mortality and serious morbidities, were significantly predicted by hypoalbuminemia. Most of the models with hypoalbuminemia showed better performance and validation in predicting postoperative complications than those without hypoalbuminemia.In colorectal cancer, hypoalbuminemia, with levels below 3.5 g/dL, serves as an excellent assessment tool and preoperative predictor of postoperative outcomes. When combined with hypoalbuminemia as a risk factor, the ACS-NSQIP Surgical Risk Calculator offers more accurate information and estimation of surgical risks to patients and surgeons when choosing treatment options.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Adjusted odds ratio plot of the association between significant postoperative outcomes with malnutrition evaluated by hypoalbuminemia. ∗P < 0.05, ∗∗P < 0.001, multivariate logistic regression. ARF = acute renal failure, CPR = cardiopulmonary resuscitation, DVT = deep vein thrombosis, OR = operation room, PRI = progressive renal insufficiency, SSI = surgical site infection.
FIGURE 2
FIGURE 2
Comparison of c-statistics in the postoperative complication models with and without hypoalbuminemia as a risk factor. Increments of the c-statistic were noted after adding hypoalbuminemia. ARF = acute renal failure, CPR = cardiopulmonary resuscitation, DVT = deep vein thrombosis, OR = operation room, PRI = progressive renal insufficiency, SSI = surgical site infection.

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References

    1. Bilimoria KY, Liu Y, Paruch JL, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013; 217:833–842.e831–e833. - PMC - PubMed
    1. Sherman SK, Hrabe JE, Charlton ME, et al. Development of an improved risk calculator for complications in proctectomy. J Gastrointest Surg 2014; 18:986–994. - PMC - PubMed
    1. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg 1991; 78:355–360. - PubMed
    1. Whiteley MS, Prytherch DR, Higgins B, et al. An evaluation of the POSSUM surgical scoring system. Br J Surg 1996; 83:812–815. - PubMed
    1. Alves A, Panis Y, Mantion G, et al. The AFC score: validation of a 4-item predicting score of postoperative mortality after colorectal resection for cancer or diverticulitis: results of a prospective multicenter study in 1049 patients. Ann Surg 2007; 246:91–96. - PMC - PubMed

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