Why the study?
Numerous prediction models estimating complication risk after esophagectomy exist but are rarely used, prompting a comparison between surgeons' clinical judgment and these models.
Does the clinical judgment of surgeons compare favorably to prediction models for estimating the risk of postoperative complications in patients undergoing esophagectomy for esophageal cancer?
Does the clinical judgment of surgeons compare favorably to prediction models for estimating the risk of postoperative complications in patients undergoing esophagectomy for esophageal cancer?
Surgeons' clinical judgment and prediction models show similar, albeit modest, accuracy in predicting postoperative complications after esophagectomy, with models tending to overestimate and surgeons underestimating risk.
Surgeon estimates may guide risk discussions comparably to models; leaves open whether hybrid approaches improve preoperative counseling in esophageal cancer.
Background Numerous prediction models estimating the risk of complications after esophagectomy exist but are rarely used in practice. The aim of this study was to compare the clinical judgment of surgeons using these prediction models. Methods Patients with resectable esophageal cancer who underwent an esophagectomy were included in this prospective study. Prediction models for postoperative complications after esophagectomy were selected by a systematic literature search. Clinical judgment was given by three surgeons, indicating their estimated risk for postoperative complications in percentage categories. The best performing prediction model was compared with the judgment of the surgeons, using the net reclassification improvement (NRI), category-free NRI (cfNRI), and integrated discrimination improvement (IDI) indexes. Results Overall, 159 patients were included between March 2019 and July 2021, of whom 88 patients (55%) developed a complication. The best performing prediction model showed an area under the receiver operating characteristic curve (AUC) of 0.56. The three surgeons had an AUC of 0.53, 0.55, and 0.59, respectively, and all surgeons showed negative percentages of cfNRI events and IDI events , and positive percentages of cfNRI nonevents and IDI events . This indicates that in the group of patients with postoperative complications, the prediction model performed better, whereas in the group of patients without postoperative complications, the surgeons performed better. NRI overall was 18% for one surgeon, while the remainder of the NRI overall , cfNRI overall and IDI overall scores showed small differences between surgeons and the prediction models. Conclusion Prediction models tend to overestimate the risk of any complication, whereas surgeons tend to underestimate this risk. Overall, surgeons’ estimations differ between surgeons and vary between similar to slightly better than the prediction models.
No takes yet. Share an insight, caveat, or question.
Hagens et al. (2023) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: