Development and validation of a prediction score for safe outpatient colorectal resections.

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State: Public
Version: author
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Serval ID
serval:BIB_27AFB3FF663E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Development and validation of a prediction score for safe outpatient colorectal resections.
Journal
Surgery
Author(s)
Grass F., Hübner M., Behm K.T., Mathis K.L., Hahnloser D., Day C.N., Harmsen W.S., Demartines N., Larson D.W.
ISSN
1532-7361 (Electronic)
ISSN-L
0039-6060
Publication state
Published
Issued date
02/2022
Peer-reviewed
Oui
Volume
171
Number
2
Pages
336-341
Language
english
Notes
Publication types: Journal Article ; Validation Study
Publication Status: ppublish
Abstract
Avoiding unnecessary inpatient stay may decrease hospital-acquired complications and costs while increasing patient satisfaction. This study aimed to develop and validate a score to identify patients eligible for safe same-day discharge after colorectal resections.
This bi-institutional retrospective cohort study included consecutive patients undergoing elective colon and rectal resections (2011-2018) for benign and malignant indications. Two multivariable logistic models were developed based on demographic and surgical risk factors to predict a combined endpoint (ileus, anastomotic leak, intra-abdominal abscess, and readmission). Development and validation datasets were randomly sampled from the entire cohort. Areas under the receiver operating characteristic curves (AUC) were evaluated, and Hosmer-Lemeshow goodness-of-fit tests were used to assess validation model fit.
Of 5,389 patients, 1,182 (21.9%) experienced at least one complication of the combined endpoint. Male gender, open surgery, ASA ≥3, wound class ≥3, ileostomy, surgical duration >3 hours, and perioperative IV fluids >3 L all had significantly greater odds of the combined endpoint in the parsimonious multivariable model (all P < .05). The reduced model considering only the 4 variables with the highest OR (>1.5) contained open surgery, ASA ≥3, wound class ≥3, and surgical duration ≥3 hours as predictors (all P < .05, AUC of 0.65; 95% CI 0.63, 0.68). Both the parsimonious model and the reduced model demonstrated no lack of fit in the validation cohort.
The suggested score composed of preand intraoperative items may help physicians decide on patients' same-day discharge after colorectal resection.
Keywords
Ambulatory Surgical Procedures/adverse effects, Clinical Decision-Making, Colon/surgery, Colonic Diseases/surgery, Female, Humans, Logistic Models, Male, Middle Aged, Patient Discharge, Postoperative Complications/prevention & control, Rectal Diseases/surgery, Rectum/surgery, Retrospective Studies, Risk Assessment/methods
Pubmed
Web of science
Open Access
Yes
Create date
21/09/2021 13:58
Last modification date
21/02/2022 7:36
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