Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; and.
Ann Surg. 2023 Jan 1;277(1):116-120. doi: 10.1097/SLA.0000000000004715. Epub 2020 Dec 18.
We sought to evaluate the performance of 2 commonly used prediction models for postoperative morbidity in patients undergoing open and minimally invasive esophagectomy.
Patients undergoing esophagectomy have a high risk of postoperative complications. Accurate risk assessment in this cohort is important for informed decision-making.
We identified patients who underwent esophagectomy between January 2016 and June 2018 from our prospectively maintained database. Predicted morbidity was calculated using the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (SRC) and a 5-factor National Surgical Quality Improvement Programderived frailty index. Performance was evaluated using concordance index (C-index) and calibration curves.
In total, 240 consecutive patients were included for analysis. Most patients (85%) underwent Ivor Lewis esophagectomy. The observed overall complication rate was 39%; the observed serious complication rate was 33%.The SRC did not identify risk of complications in the entire cohort (C-index, 0.553), patients undergoing open esophagectomy (C-index, 0.569), or patients undergoing minimally invasive esophagectomy (C-index, 0.542); calibration curves showed general underestimation. Discrimination of the SRC was lowest for reoperation (C-index, 0.533) and highest for discharge to a facility other than home (C-index, 0.728). Similarly, the frailty index had C-index of 0.513 for discriminating any complication, 0.523 for serious complication, and 0.559 for readmission.
SRC and frailty index did not adequately predict complications after esophagectomy. Procedure-specific risk-assessment tools are needed to guide shared patient-physician decision-making in this high-risk population.
我们旨在评估两种常用于开腹和微创食管切除术患者术后发病率预测模型的性能。
接受食管切除术的患者术后发生并发症的风险较高。在该队列中进行准确的风险评估对于知情决策很重要。
我们从我们的前瞻性维护数据库中确定了 2016 年 1 月至 2018 年 6 月期间接受食管切除术的患者。使用美国外科医师学院国家外科质量改进计划手术风险计算器（SRC）和 5 个因素国家外科质量改进计划衍生的虚弱指数来计算预测发病率。使用一致性指数（C 指数）和校准曲线评估性能。
共有 240 例连续患者纳入分析。大多数患者（85％）接受了 Ivor Lewis 食管切除术。观察到的总体并发症发生率为 39％；观察到的严重并发症发生率为 33％。SRC 未能识别整个队列的并发症风险（C 指数为 0.553），开腹食管切除术患者（C 指数为 0.569）或微创食管切除术患者（C 指数为 0.542）；校准曲线显示总体低估。SRC 对再次手术的鉴别能力最低（C 指数为 0.533），对出院到非家庭医疗机构的鉴别能力最高（C 指数为 0.728）。同样，虚弱指数对任何并发症的鉴别能力为 0.513，严重并发症为 0.523，再入院为 0.559。
SRC 和虚弱指数不能充分预测食管切除术后的并发症。需要特定于手术的风险评估工具来指导这一高危人群中患者与医生的共同决策。
