title: Postoperative 30-day mortality in patients undergoing surgery for colorectal cancer: development of a prognostic model using administrative claims data.
abstract: OBJECTIVE
  To develop a prognostic model to predict 30-day mortality following colorectal cancer (CRC) surgery using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked data and to assess whether race/ethnicity, neighborhood, and hospital characteristics influence model performance.
  
  
  METHODS
  We included patients aged 66 years and older from the linked 2000-2005 SEER-Medicare database. Outcome included 30-day mortality, both in-hospital and following discharge. Potential prognostic factors included tumor, treatment, sociodemographic, hospital, and neighborhood characteristics (census-tract-poverty rate). We performed a multilevel logistic regression analysis to account for nesting of CRC patients within hospitals. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) for discrimination and the Hosmer-Lemeshow goodness-of-fit test for calibration.
  
  
  RESULTS
  In a model that included all prognostic factors, important predictors of 30-day mortality included age at diagnosis, cancer stage, and mode of presentation. Race/ethnicity, census-tract-poverty rate, and hospital characteristics were independently associated with 30-day mortality, but they did not influence model performance. Our SEER-Medicare model achieved moderate discrimination (AUC = 0.76), despite suboptimal calibration.
  
  
  CONCLUSIONS
  We developed a prognostic model that included tumor, treatment, sociodemographic, hospital, and neighborhood predictors. Race/ethnicity, neighborhood, and hospital characteristics did not improve model performance compared with previously developed models.
authors.affiliation: Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA.
authors.forename: S
authors.initials: S
authors.lastname: de Vries
authors.forename: D B
authors.initials: DB
authors.lastname: Jeffe
authors.forename: N O
authors.initials: NO
authors.lastname: Davidson
authors.forename: A D
authors.initials: AD
authors.lastname: Deshpande
authors.forename: M
authors.initials: M
authors.lastname: Schootman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008962:Models, Theoretical; D011184:Postoperative Period; D011379:Prognosis; D018426:SEER Program; D014481:United States / Q000453:epidemiology
references.citation: J Gastrointest Surg. 2011 Feb;15(2):294-303
references.pmid: 20936370
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-43-8
references.pmid: 12187167
references.citation: Eur J Surg Oncol. 2011 Nov;37(11):956-63
references.pmid: 21944049
references.citation: Colorectal Dis. 2007 Jan;9(1):28-37
references.pmid: 17181843
references.citation: J Gastrointest Surg. 2010 Oct;14(10):1511-20
references.pmid: 20824372
references.citation: Cochrane Database Syst Rev. 2012 Mar 14;(3):CD005391
references.pmid: 22419309
references.citation: CA Cancer J Clin. 2013 Jan;63(1):11-30
references.pmid: 23335087
references.citation: Med Care. 2013 Jul;51(7):597-605
references.pmid: 23604015
references.citation: J R Soc Med. 2001 Dec;94(12):632-4
references.pmid: 11733590
references.citation: Nat Clin Pract Oncol. 2005 Jul;2(7):258-9
references.pmid: 16075798
references.citation: BMJ. 2003 Nov 22;327(7425):1196-201
references.pmid: 14630754
references.citation: Med Care. 2002 Aug;40(8 Suppl):IV-3-18
references.pmid: 12187163
references.citation: Arch Surg. 2007 Jan;142(1):23-31; discussion 32
references.pmid: 17224497
references.citation: Tech Coloproctol. 2010 Mar;14(1):9-12
references.pmid: 19953287
references.citation: Stat Med. 1996 Feb 28;15(4):361-87
references.pmid: 8668867
references.citation: Am J Epidemiol. 2012 Sep 15;176(6):473-81
references.pmid: 22875755
references.citation: Gut. 2011 Jun;60(6):806-13
references.pmid: 21486939
references.citation: BMJ. 2009 Mar 31;338:b604
references.pmid: 19336487
references.citation: Br J Surg. 1998 Sep;85(9):1217-20
references.pmid: 9752863
references.citation: J Clin Epidemiol. 2000 Dec;53(12):1258-67
references.pmid: 11146273
references.citation: BMC Med Inform Decis Mak. 2013 Feb 27;13:28
references.pmid: 23442316
references.citation: Eur J Surg Oncol. 2012 Nov;38(11):1071-8
references.pmid: 22703758
references.citation: Br J Surg. 1991 Mar;78(3):355-60
references.pmid: 2021856
references.citation: Br J Surg. 1994 Oct;81(10):1492-4
references.pmid: 7820482
references.citation: Br J Surg. 2004 Sep;91(9):1174-82
references.pmid: 15449270
references.citation: Dis Colon Rectum. 2004 Dec;47(12):2015-24
references.pmid: 15657649
references.citation: Dis Colon Rectum. 2004 Sep;47(9):1435-41
references.pmid: 15486738
references.citation: Eur Heart J. 2008 Feb;29(4):436-40
references.pmid: 18276616
references.citation: Dis Colon Rectum. 1996 Jun;39(6):654-8
references.pmid: 8646952
references.citation: Br J Surg. 2011 Jun;98(6):854-65
references.pmid: 21452190
references.citation: Am J Surg. 2013 Apr;205(4):402-8
references.pmid: 23375764
references.citation: Lancet Oncol. 2007 Apr;8(4):317-22
references.pmid: 17395105
references.citation: Dis Colon Rectum. 1996 Feb;39(2):129-35
references.pmid: 8620777
references.citation: Cancer Causes Control. 2013 Mar;24(3):473-84
references.pmid: 23306551
references.citation: J Clin Oncol. 2006 Sep 10;24(26):4277-84
references.pmid: 16963730
references.citation: Stat Med. 1997 May 15;16(9):965-80
references.pmid: 9160492
references.citation: Surg Oncol. 2004 Aug-Nov;13(2-3):83-92
references.pmid: 15572090
references.citation: Health Serv Res. 2014 Aug;49(4):1145-64
references.pmid: 24673560