title: Nomogram to predict risk of 30-day morbidity and mortality for patients with disseminated malignancy undergoing surgical intervention.
abstract: OBJECTIVE
  To estimate individual risk of 30-day surgical morbidity and mortality after surgical intervention for patients with disseminated malignancy (DMa).
  
  
  BACKGROUND
  Patients with DMa frequently require surgical consultation for palliative operations. Although these patients are at high risk for surgical morbidity and mortality, limited data exist allowing individual risk stratification.
  
  
  METHODS
  Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2005 to 2007, we identified 7447 patients with DMa. Each of the 53 preoperative ACS NSQIP variables was analyzed to assess risk of morbidity and mortality. Logistic regression models were developed using stepwise model selection and generalized additive models. Covariates were evaluated for nonlinearity and interactions among variables. We constructed nomograms utilizing clinically and statistically significant covariates to predict 30-day risk of morbidity and mortality.
  
  
  RESULTS
  Overall 30-day unadjusted morbidity and mortality rates were 28.3% and 8.9%, respectively. Mortality rates reached 18.4% for vascular procedures and 27.9% for emergent operations. Increasing age, impaired functional status, Do-Not-Resuscitate status, impaired respiratory function, ascites, hypoalbuminema, elevated creatinine, and abnormal WBC were all significant predictors (P < 0.0001) of increased morbidity and mortality on multivariate analysis. Nomograms to predict individual 30-day risk of complications and death based on preoperative factors were developed and validated by bootstrapping. Concordance indices were 0.704 and 0.861 for morbidity and mortality, respectively.
  
  
  CONCLUSIONS
  Surgical intervention among patients with DMa is associated with substantial morbidity and mortality. We have constructed nomograms to predict individual risk of 30-day morbidity and mortality. These have significant implications for surgical decision-making in this group of patients.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, University of California at Davis Medical Center, Sacramento, CA 95817, USA.
authors.forename: Warren H
authors.initials: WH
authors.lastname: Tseng
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Yang
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.forename: Steve R
authors.initials: SR
authors.lastname: Martinez
authors.forename: Steven L
authors.initials: SL
authors.lastname: Chen
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Meyers
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Bold
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Canter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis / Q000473:pathology* / Q000628:therapy*; D049451:Nomograms; D010166:Palliative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D011336:Probability; D058996:Quality Improvement; D015996:Survival Rate; D014481:United States; D055815:Young Adult