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Operative mortality in colorectal cancer: prospective national study

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7425.1196 (Published 20 November 2003) Cite this as: BMJ 2003;327:1196

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  1. Paris P Tekkis, resident surgical officer1,
  2. Jan D Poloniecki, senior lecturer in biostatistics2,
  3. Michael R Thompson, consultant surgeon3,
  4. Jeffrey D Stamatakis, consultant surgeon (jeff.stamatakis{at}bromor-tr.wales.nhs.uk)4 on behalf of the Association of Coloproctology of Great Britain and Ireland
  1. 1Department of Surgery, St Mark's Hospital, Harrow HA1 3UJ,
  2. 2Department of Public Health Sciences, St George's Hospital, London SW17 0WT,
  3. 3Department of Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY,
  4. 4Department of Surgery, Princess of Wales Hospital, Bridgend CF31 1RQ
  1. Correspondence to: J D Stamatakis

    Abstract

    Objective To develop a mathematical model that will predict the probability of death after surgery for colorectal cancer.

    Design Descriptive study using routinely collected clinical data.

    Data source The database of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), encompassing 8077 patients with a new diagnosis of colorectal cancer in 73 hospitals during a 12 month period.

    Statistical analysis A three level hierarchical logistic regression model was used to identify independent predictors of operative mortality. The model was developed on 60% of the patient population and its validity tested on the remaining 40%.

    Results Overall postoperative mortality was 7.5% (95% confidence interval 6.9% to 8.1%). Independent predictors of death were age, American Society of Anesthesiology (ASA) grade, Dukes's stage, urgency of the operation, and cancer excision. When tested the predictive model showed good discrimination (area under the receiver operating characteristic curve = (0.775) and calibration (comparison of observed with expected mortality across different procedures; Hosmer-Lemeshow statistic = 6.34, 8 df, P = 0.610).

    Conclusions Clinicians can predict postoperative death by using a simple numerical table derived from the statistical model of the ACPGBI. The model can be used in everyday practice for preoperative counselling of patients and their carers as a part of multidisciplinary care. It may also be used to compare the outcomes between multidisciplinary teams for colorectal cancer.

    Footnotes

    • Contributors JDS and MRT initiated the study; data harvesting and data aggregation were undertaken by PPT and JDS; data analysis and risk modelling were performed by PPT and JDP; drafting of this report was undertaken by PPT and edited by JDP, MRT, and JDS. All investigators contributed comments and corrections on the final draft. JDS and PPT are guarantors of the study.

    • Funding PPT is funded by the Hue Falwasser research fellowship of the Royal College of Surgeons of England.

    • Competing interests None declared.

    • Ethical approval The study was approved by the multicentre ethics research committee for Wales, 10 January 2001.

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