Operative mortality in colorectal cancer: prospective national study

doi:10.1136/bmj.327.7425.1196

BMJ 2003;327:1196-1201 (22 November), doi:10.1136/bmj.327.7425.1196

Paper

Operative mortality in colorectal cancer: prospective national study

Paris P Tekkis, resident surgical officer¹, Jan D Poloniecki, senior lecturer in biostatistics², Michael R Thompson, consultant surgeon³, Jeffrey D Stamatakis, consultant surgeon⁴, on behalf of the Association of Coloproctology of Great Britain and Ireland

¹ Department of Surgery, St Mark's Hospital, Harrow HA1 3UJ, ² Department of Public Health Sciences, St George's Hospital, London SW17 0WT, ³ Department of Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, ⁴ Department of Surgery, Princess of Wales Hospital, Bridgend CF31 1RQ

Correspondence to: J D Stamatakis jeff.stamatakis{at}bromor-tr.wales.nhs.uk

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

Design Descriptive study using routinely collected clinicaldata.

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

Statistical analysis A three level hierarchical logistic regressionmodel was used to identify independent predictors of operativemortality. The model was developed on 60% of the patient populationand its validity tested on the remaining 40%.

Results Overall postoperative mortality was 7.5% (95% confidenceinterval 6.9% to 8.1%). Independent predictors of death wereage, American Society of Anesthesiology (ASA) grade, Dukes'sstage, urgency of the operation, and cancer excision. When testedthe predictive model showed good discrimination (area underthe receiver operating characteristic curve = (0.775) and calibration(comparison of observed with expected mortality across differentprocedures; Hosmer-Lemeshow statistic = 6.34, 8 df, P = 0.610).

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

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