外科医生评估与风险模型预测肝胰胆手术并发症的比较（HPB-RISC）：一项多中心前瞻性队列研究。

Surgeons' assessment versus risk models for predicting complications of hepato-pancreato-biliary surgery (HPB-RISC): a multicenter prospective cohort study.

机构信息

Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands; Department of Surgery, University Hospital Southampton NHS Trust Foundation, United Kingdom.

Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands.

出版信息

HPB (Oxford). 2018 Sep;20(9):809-814. doi: 10.1016/j.hpb.2018.02.635. Epub 2018 Apr 17.

DOI:10.1016/j.hpb.2018.02.635

PMID:29678364

Abstract

BACKGROUND

Several studies advise the use of risk models when counseling patients for hepato-pancreato-biliary (HPB) surgery, but studies comparing these models to the surgeons' assessment are lacking. The aim of this study was to assess whether risk prediction models outperform surgeons' assessment for the risk of complications in HPB surgery.

METHODS

This prospective study included adult patients scheduled for HPB surgery in three centers in the UK and the Netherlands. Primary outcome was the rate of postoperative major complications. Surgeons assessed the risk prior to surgery while blinded for the formal risk scores. Risk prediction models were retrieved via a systematic review and risk scores were calculated. For each model, discrimination and calibration were evaluated.

RESULTS

Overall, 349 patients were included. The rate of major complications was 27% and in-hospital mortality 3%. Surgeons' assessment resulted in an AUC of 0.64; 0.71 for liver and 0.56 for pancreas surgery (P = 0.020). The AUCs for nine existing risk prediction models ranged between 0.57 and 0.73 for liver surgery and between 0.51 and 0.57 for pancreas surgery.

CONCLUSION

In HPB surgery, existing risk prediction models do not outperform surgeons' assessment. Surgeons' assessment outperforms most risk prediction models for liver surgery although both have a poor predictive performance for pancreas surgery.

REGISTRATION INFORMATION

REC reference number (13/SC/0135); IRAS ID (119370). TRIALREGISTER.NL: NTR4649.

摘要

背景

多项研究建议在为肝胆管手术患者提供咨询时使用风险模型，但缺乏将这些模型与外科医生评估进行比较的研究。本研究旨在评估风险预测模型是否优于外科医生对肝胆管手术并发症风险的评估。

方法

这项前瞻性研究纳入了在英国和荷兰的三个中心接受肝胆管手术的成年患者。主要结局是术后主要并发症的发生率。外科医生在手术前进行风险评估，同时对正式风险评分进行盲法评估。通过系统回顾检索风险预测模型，并计算风险评分。对每个模型进行判别和校准评估。

结果

共纳入 349 例患者。主要并发症发生率为 27%，院内死亡率为 3%。外科医生的评估得出的 AUC 为 0.64；肝脏手术为 0.71，胰腺手术为 0.56（P=0.020）。9 种现有风险预测模型在肝脏手术中的 AUC 范围为 0.57 至 0.73，在胰腺手术中的 AUC 范围为 0.51 至 0.57。