title: 30-day mortality after elective colorectal surgery can reasonably be predicted.
abstract: BACKGROUND
  The aim of the present study was to develop a clinically relevant, accurate and usable risk assessment scoring system solely for colorectal cancer patients undergoing elective resection.
  
  
  METHODS
  All colorectal resections for colorectal cancer 2006-2012 were identified from the American College of Surgeons Quality Improvement Program. Independent risk factors for 30-day mortality after elective surgery were identified using univariable and multivariable logistic regression. A points-calculator based on factors most strongly associated with mortality and accurately predicting risk of mortality was developed.
  
  
  RESULTS
  Fifty-nine thousand nine hundred eighty-six patients underwent elective colorectal cancer surgery, and 1096 (1.8 %) died within 30 days. On multivariable analysis, the strongest risk factors for mortality were age ≥65 years [odds ratio (OR) 2.17, 95 % confidence interval (CI) 1.61-2.92], American Society of Anesthesiologists score ≥3 (OR 1.77, 95 % CI 1.29-2.42), renal failure (OR 3.15, 95 % CI 1.01-9.77), disseminated cancer (OR 2.56, 95 % CI 1.96-3.35), hypoalbuminemia (OR 2.84, 95 % CI 2.21-3.65), preoperative ascites (OR 3.17, 95 % CI 2.07-4.87), heart failure (OR 2.08, 95 % CI 1.35-3.20) and functional status (OR 2.05, 95 % CI 1.56-2.70). A model that accurately predicted risk of mortality was created using forward stepwise logistic regression and externally validated (area under the curve 0.826). This allowed for development of an eight-factor predictive score; maximum points conferred mortality of 96.1 % (p < 0.0001).
  
  
  CONCLUSIONS
  A simple preoperative scoring system predicting 30-day mortality with good capability may allow better preoperative risk assessment, optimization and decision-making.
authors.affiliation: Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Murray
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: C
authors.initials: C
authors.lastname: Mauro
authors.affiliation: Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA.
authors.forename: J
authors.initials: J
authors.lastname: Rein
authors.affiliation: Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA. rpk2118@cumc.columbia.edu.|Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA. rpk2118@cumc.columbia.edu.
authors.forename: R P
authors.initials: RP
authors.lastname: Kiran
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000453:epidemiology; D003082:Colectomy / Q000379:methods / Q000401:mortality*; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000401:mortality; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D012007:Rectum / Q000601:surgery*; D051437:Renal Insufficiency / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Colorectal cancer; Mortality; Outcomes; Risk prediction