A simple risk score to predict in-hospital mortality after pancreatic resection for cancer
Authors
Hill, Joshua S.Zhou, Zheng
Simons, Jessica P.
Ng, Sing Chau
McDade, Theodore P.
Whalen, Giles F.
Tseng, Jennifer F.
UMass Chan Affiliations
Department of SurgeryDocument Type
Journal ArticlePublication Date
2010-07-16Keywords
AgedAged, 80 and over
Cohort Studies
Comorbidity
Female
Hospital Mortality
Humans
Inpatients
Male
Middle Aged
*Pancreatectomy
Pancreatic Neoplasms
Risk Assessment
Risk Factors
Survival Rate
Treatment Outcome
Surgery
Metadata
Show full item recordAbstract
BACKGROUND: Pancreatectomy for cancer continues to have substantial perioperative risk, and the factors affecting mortality are ill defined. An integer-based risk score based on national data might help clarify the risk of in-hospital mortality in patients undergoing pancreatic resection. METHODS: Records with the diagnosis of pancreatic cancer were queried from the Nationwide Inpatient Sample for 1998-2006. Procedures were categorized as proximal, distal, or nonspecified pancreatectomies on the basis of ICD-9 codes. Logistic regression and bootstrap methods were used to create an integer risk score for estimating the risk of in-hospital mortality using patient demographics, comorbidities (Charlson comorbidity score), procedure, and hospital type. A random sample of 80% of the cohort was used to create the risk score with a 20% internal validation set. RESULTS: A total of 5715 patient discharges were identified. Composite in-hospital mortality was 5.8%. Predictors used for the final model were age group, Charlson score, sex, type of pancreatectomy, and hospital volume status (low-, medium-, or high-volume center). Integer values were assigned to these characteristics and then used for calculating an additive score. Three clinically useful score groups were defined to stratify the risk of in-hospital mortality (mortality was 2.0, 6.2, and 13.9%, respectively; P < 0.0001), with a 6.95-fold difference between the low- and high-risk groups. There was sufficient discrimination of both the derivation set and the validation set, with c statistics of 0.71 and 0.72, respectively. CONCLUSIONS: An integer-based risk score can be used to accurately predict in-hospital mortality after pancreatectomy and may be useful for preoperative risk stratification and patient counseling.Source
Ann Surg Oncol. 2010 Jul;17(7):1802-7. Epub 2010 Feb 13. Link to article on publisher's siteDOI
10.1245/s10434-010-0947-xPermanent Link to this Item
http://hdl.handle.net/20.500.14038/49794PubMed ID
20155401Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1245/s10434-010-0947-x