Lin Viviane, Gögenur Seyma, Pachler Frederik, Fransgaard Tina, Gögenur Ismail
Center for Surgical Science, Department of Surgery, Zealand University Hospital Køge, Denmark.
Department of Surgery, Herlev Hospital, HerlevDenmark.
J Crohns Colitis. 2023 Jan 27;17(1):73-82. doi: 10.1093/ecco-jcc/jjac114.
Many patients with inflammatory bowel disease [IBD] require surgery during their disease course. Having individual risk predictions available prior to surgery could aid in better informed decision making for personalised treatment trajectories in IBD surgery. The American College of Surgeons National Surgical Quality Improvement Program [ACS NSQIP] has developed a surgical risk calculator that calculates risks for postoperative outcomes using 20 patient and surgical predictors. We aimed to validate the calculator for IBD surgery to determine its accuracy in this patient cohort.
Predicted risks were calculated for patients operated for IBD between December 2017 and January 2022 at two tertiary centres and compared with actual outcomes within 30 postoperative days. Predictive performance was assessed for several postoperative complications, using metrics for discrimination and calibration.
Risks were calculated for 508 patient trajectories undergoing surgery for IBD. Incidence of any complication, serious complications, reoperation, and readmission were 32.1%, 21.1%, 15.2%, and 18.3%, respectively. Of 212 patients with an anastomosis, 19 experienced leakage [9.0%]. Discriminative performance and calibration were modest. Risk prediction for any complication, serious complication, reoperation, readmission, and anastomotic leakage had a c statistic of 0.605 (95% confidence interval [CI] 0.534-0.640), 0.623 [95% CI 0.558-0.688], 0.590 [95% CI 0.513-0.668], 0.621 [95% CI 0.557-0.685], and 0.574 [95% CI 0.396-0.751], respectively, and a Brier score of 0.240, 0.166, 0.138, 0.152, and 0.113, respectively.
The accuracy of risks calculated by the ACS NSQIP Surgical Risk Calculator was deemed insufficient for patients undergoing surgery for IBD, generally underestimating postoperative risks. Recalibration or additional variables could be necessary to predict risks in this cohort.
许多炎症性肠病（IBD）患者在病程中需要接受手术。术前获得个体风险预测有助于在IBD手术中为个性化治疗方案做出更明智的决策。美国外科医师学会国家外科质量改进计划（ACS NSQIP）开发了一种手术风险计算器，该计算器使用20个患者和手术预测指标来计算术后结果的风险。我们旨在验证该计算器在IBD手术中的准确性，以确定其在该患者队列中的精确性。
计算了2017年12月至2022年1月期间在两个三级中心接受IBD手术患者的预测风险，并与术后30天内的实际结果进行比较。使用区分度和校准指标评估了几种术后并发症的预测性能。
计算了508例接受IBD手术患者轨迹的风险。任何并发症、严重并发症、再次手术和再次入院的发生率分别为32.1%、21.1%、15.2%和18.3%。在212例进行吻合术的患者中，19例发生渗漏（9.0%）。区分性能和校准效果一般。任何并发症、严重并发症、再次手术、再次入院和吻合口渗漏的风险预测的c统计量分别为0.605（95%置信区间[CI]0.534 - 0.640）、0.623[95%CI 0.558 - 0.688]、0.590[95%CI 0.513 - 0.668]、0.621[95%CI 0.557 - 0.685]和0.574[95%CI 0.396 - 0.751]，Brier评分分别为0.240、0.166、0.138、0.152和0.113。
ACS NSQIP手术风险计算器计算的风险准确性被认为不足以用于IBD手术患者，通常低估了术后风险。可能需要重新校准或增加变量来预测该队列中的风险。
