title: Predicting postoperative mortality after colorectal surgery: a novel clinical model.
abstract: OBJECTIVE
  The aim of this study was to develop and externally validate a clinically, practical and discriminative prediction model designed to estimate in-hospital mortality of patients undergoing colorectal surgery.
  
  
  METHODS
  All consecutive patients who underwent elective or emergency colorectal surgery from 1990 to 2005, at the Zaandam Medical Centre, The Netherlands, were included in this study. Multivariate logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) linking the explanatory variables to the outcome variable in-hospital mortality, and a simplified Identification of Risk in Colorectal Surgery (IRCS) score was constructed. The model was validated in a population of patients who underwent colorectal surgery from 2005 to 2011 in Barcelona, Spain. Predictive performance was estimated by calculating the area under the receiver operating characteristic curve.
  
  
  RESULTS
  The strongest predictors of in-hospital mortality were emergency surgery (OR = 6.7, 95% CI 4.7-9.5), tumour stage (OR = 3.2, 95% CI 2.8-4.6), age (OR = 13.1, 95% CI 6.6-26.0), pulmonary failure (OR = 4.9, 95% CI 3.3-7.1) and cardiac failure (OR = 3.7, 95% CI 2.6-5.3). These parameters were included in the prediction model and simplified scoring system. The IRCS model predicted in-hospital mortality and demonstrated a predictive performance of 0.83 (95% CI 0.79-0.87) in the validation population. In this population the predictive performance of the CR-POSSUM score was 0.76 (95% CI 0.71-0.81).
  
  
  CONCLUSIONS
  The results of this study have shown that the IRCS score is a good predictor of in-hospital mortality after colorectal surgery despite the relatively low number of model parameters.
authors: Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: F J
authors: FJ
authors: van der Sluis
authors: E
authors: E
authors: Espin
authors: F
authors: F
authors: Vallribera
authors: G H
authors: GH
authors: de Bock
authors: H J
authors: HJ
authors: Hoekstra
authors: B L
authors: BL
authors: van Leeuwen
authors: A F
authors: AF
authors: Engel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003107:Colorectal Surgery / Q000401:mortality*; D004638:Emergency Treatment / Q000401:mortality; D005260:Female; D006333:Heart Failure; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D016017:Odds Ratio; D011184:Postoperative Period; D012131:Respiratory Insufficiency; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment / Q000379:methods; D013030:Spain
keywords: Colorectal surgery; clinical prediction rule; colorectal cancer; hospital mortality