急诊手术治疗梗阻性结肠癌的死亡率风险分层-国际评分、美国外科医师学会国家外科质量改进计划外科风险计算器（SRC）和法国外科协会专用评分（AFC/OCC 评分）的外部验证。

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).

机构信息

Clinic Surgery Department, Dunarea de Jos University, 800216 Galati, Romania.

Morphological and Functional Sciences Department, Dunarea de Jos University, 800216 Galati, Romania.

出版信息

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

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.

背景

梗阻性结肠癌（OCC）急诊手术后的死亡率增加，需要使用风险分层评分。本研究旨在对手术风险计算器（SRC）和 AFC/OCC 评分进行外部验证，并创建一个风险分层评分。

方法

回顾性分析了 435 例 OCC 急诊手术患者。我们使用了适合目的的统计方法。

结果

术后死亡率为 11.72%。SRC 表现：强判别力（AUC=0.864）和极好的校准度（11.80%预测值与 11.72%观察值）；AFC/OCC 评分表现：适度判别力（AUC=0.787）和低估死亡率（6.93%预测值与 11.72%观察值）。我们确定了九个术后死亡率的预测因素：年龄>70 岁、充血性心力衰竭、ECOG>2、败血症、肥胖或恶病质、肌酐（aN）或血小板（aN）和近端肿瘤（AUC=0.947）。基于该评分，我们得到了四个死亡率风险组：低风险（0.7%）-0-2 个因素，中风险（12.5%）-3 个因素，高风险（40.0%）-4 个因素，极高风险（84.4%）-5-6 个因素。