Mortality Risk Stratification in Emergency Surgery for Obstructive Colon Cancer-External Validation of International Scores, American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (SRC), and the Dedicated Score of French Surgical Association (AFC/OCC Score)

Raul Mihailov; Dorel Firescu; Georgiana Bianca Constantin; Oana Mariana Mihailov; Petre Hoara; Rodica Birla; Traian Patrascu; Eugenia Panaitescu

doi:10.3390/ijerph192013513

Mortality Risk Stratification in Emergency Surgery for Obstructive Colon Cancer-External Validation of International Scores, American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (SRC), and the Dedicated Score of French Surgical Association (AFC/OCC Score)

Int J Environ Res Public Health. 2022 Oct 19;19(20):13513. doi: 10.3390/ijerph192013513.

Authors

Raul Mihailov¹, Dorel Firescu¹, Georgiana Bianca Constantin², Oana Mariana Mihailov³, Petre Hoara⁴, Rodica Birla⁴, Traian Patrascu⁴, Eugenia Panaitescu⁵

Affiliations

¹ Clinic Surgery Department, Dunarea de Jos University, 800216 Galati, Romania.
² Morphological and Functional Sciences Department, Dunarea de Jos University, 800216 Galati, Romania.
³ Clinic Medical Department, Dunarea de Jos University, 800216 Galati, Romania.
⁴ General Surgery Department, Carol Davila University, 050474 Bucharest, Romania.
⁵ Medical Informatics and Biostatistics Department, Carol Davila University, 050474 Bucharest, Romania.

Abstract

Background: The increased rates of postoperative mortality after emergency surgery for obstructive colon cancer (OCC) require the use of risk-stratification scores. The study purpose is to external validate the surgical risk calculator (SRC) and the AFC/OCC score and to create a score for risk stratification.

Patients and methods: Overall, 435 patients with emergency surgery for OCC were included in this retrospective study. We used statistical methods suitable for the aimed purpose.

Results: Postoperative mortality was 11.72%. SRC performance: strong discrimination (AUC = 0.864) and excellent calibration (11.80% predicted versus 11.72% observed); AFC/OCC score performance: adequate discrimination (AUC = 0.787) and underestimated mortality (6.93% predicted versus 11.72% observed). We identified nine predictors of postoperative mortality: age > 70 years, CHF, ECOG > 2, sepsis, obesity or cachexia, creatinine (aN) or platelets (aN), and proximal tumors (AUC = 0.947). Based on the score, we obtained four risk groups of mortality rate: low risk (0.7%)-0-2 factors, medium risk (12.5%)-3 factors, high risk (40.0%)-4 factors, very high risk (84.4%)-5-6 factors.

Conclusions: The two scores were externally validated. The easy identification of predictors and its performance recommend the mortality score of the Clinic County Emergency Hospital of Galați/OCC for clinical use.

Keywords: emergency care; external validation; obstructive colon cancer; prediction.

MeSH terms

Aged
Colonic Neoplasms* / surgery
Creatinine
Humans
Quality Improvement
Retrospective Studies
Risk Assessment / methods
Risk Factors
Surgeons*
United States

Substances

Creatinine

Grants and funding

This research received no external funding.