Rutegård Martin, Matthiessen Peter, Rutegård Jörgen, Haapamäki Markku M, Svensson Johan
Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden.
Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden.
BJS Open. 2024 Dec 30;9(1). doi: 10.1093/bjsopen/zrae153.
Postoperative death measured 30 days after surgery is a conventional quality metric, whereas intervals up to 90 days are increasingly used, although data-driven time windows have scarcely been investigated.
The Swedish Colorectal Cancer Registry was used to identify all patients subjected resection for colorectal cancer between 2007 and 2020. All patients were followed up until 180 days after surgery. A join-point statistical hazard model was used to model a declining hazard to a transition point, followed by a stable death rate. This method was subsequently applied to describe postoperative deaths for the entire cohort and subgroups according to tumour location (colon and rectum).
Some 56 096 patients electively operated on for colorectal cancer during the study interval were included, with a 30-day and 90-day fatality of 805 (1.43%) and 1458 (2.60%) patients respectively. The derived postoperative fatality window, after which the death rate transitioned to a stable rate, was 23.8 (95% c.i. 21.5 to 28.2) days after surgery. There was no significant difference in the time window between rectal cancer (22.9 days; 95% c.i. 15.1 to 28.4) and colon cancer (27.3 days; 95% c.i. 21.4 to 31.8) patients (P = 0.455). However, postoperative fatality time windows were extended in patients aged at least 80 years and with American Society of Anesthesiologists' grade III or IV.
The traditional postoperative time window of 30 days was confirmed to be an appropriate metric in elective colorectal cancer surgery when evaluated with a hazards-based statistical framework. Importantly, this time window is influenced by older age and advanced co-morbidity, which could prompt increased vigilance for these patient groups.
术后30天测量的术后死亡是一种传统的质量指标，而90天以内的时间段也越来越多地被使用，尽管基于数据驱动的时间窗很少被研究。
利用瑞典结直肠癌登记处识别2007年至2020年间所有接受结直肠癌切除术的患者。所有患者均随访至术后180天。采用连接点统计风险模型对风险下降至转折点，随后死亡率稳定的情况进行建模。该方法随后用于描述整个队列以及根据肿瘤位置（结肠和直肠）划分的亚组的术后死亡情况。
在研究期间，约56096例接受择期结直肠癌手术的患者被纳入研究，30天和90天的死亡人数分别为805例（1.43%）和1458例（2.60%）。术后死亡风险率转变为稳定率的推导死亡窗口为术后23.8天（95%置信区间21.5至28.2天）。直肠癌患者（22.9天；95%置信区间15.1至28.4天）和结肠癌患者（27.3天；95%置信区间21.4至31.8天）的时间窗无显著差异（P = 0.455）。然而，年龄至少80岁以及美国麻醉医师协会分级为III级或IV级的患者术后死亡时间窗延长。
当采用基于风险的统计框架进行评估时，传统的30天术后时间窗被证实是择期结直肠癌手术的一个合适指标。重要的是，这个时间窗受年龄较大和合并症严重程度的影响，这可能促使对这些患者群体提高警惕。
