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)

Raul Mihailov, Dorel Firescu, Georgiana Bianca Constantin, Oana Mariana Mihailov, Petre Hoara, Rodica Birla (), Traian Patrascu and Eugenia Panaitescu
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Raul Mihailov: Clinic Surgery Department, Dunarea de Jos University, 800216 Galati, Romania
Dorel Firescu: Clinic Surgery Department, Dunarea de Jos University, 800216 Galati, Romania
Georgiana Bianca Constantin: Morphological and Functional Sciences Department, Dunarea de Jos University, 800216 Galati, Romania
Oana Mariana Mihailov: Clinic Medical Department, Dunarea de Jos University, 800216 Galati, Romania
Petre Hoara: General Surgery Department, Carol Davila University, 050474 Bucharest, Romania
Rodica Birla: General Surgery Department, Carol Davila University, 050474 Bucharest, Romania
Traian Patrascu: General Surgery Department, Carol Davila University, 050474 Bucharest, Romania
Eugenia Panaitescu: Medical Informatics and Biostatistics Department, Carol Davila University, 050474 Bucharest, Romania

IJERPH, 2022, vol. 19, issue 20, 1-22

Abstract: 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.

Keywords: external validation; prediction; emergency care; obstructive colon cancer (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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