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November 16, 2023Open Access

Prediction of 30-day, 90-day and 1 year mortality after colorectal cancer surgery using a data-driven approach

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Key result

A data-driven prediction model using preoperative data accurately predicted 30-day, 90-day, and 1-year mortality after colorectal cancer surgery with AUROCs of 0.88, 0.878, and 0.861, respectively.

Why the study?

Existing postoperative mortality risk scores after colorectal cancer resection rely on intra- or postoperative variables or fail to represent contemporary clinical practice.

Population

57,558 patients undergoing colorectal cancer surgery across four Danish databases

Comparison

Preoperative data-driven prediction models for 30-day, 90-day, and 1-year mortality

Design

Observational database-derived prediction model development study

Follow-up

1 year

Authors

KBKaroline Bendix BräunerPsychiatry Region ZealandATAndi TsouchnikaZealand University Hospital KøgeMMMaliha MashkoorSino-Danish Centre for Education and Research

Discussion

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Implication

Models for post-CRC surgery mortality may aid risk stratification; leaves open external validation and clinical utility.

Study Design

Type

Observational (n=57,558)

Multicenter

Yes

Structured PICO

P
Population
57,558 adult patients undergoing surgery for colorectal cancer in Denmark, evaluated to develop and internally validate a prediction model for short-term mortality.
O
Outcome
All-cause mortality within 30 days, 90 days, and 1 year after CRC surgeryhard clinical

A data-driven machine learning approach using nationwide health databases successfully developed highly discriminative and well-calibrated prediction models for short-term mortality after colorectal cancer surgery.

Limitations

  • The models utilized a large number of covariates (419 to 581), which is currently infeasible for routine clinical implementation without parsimonious models.
  • Lack of external validation in international cohorts.
  • Inability to distinguish between a true lack of a condition and missing data in some of the electronic health record databases.
  • Subgroup analyses showed a tendency for the model to underestimate risk in certain clinical scenarios.
  • Data-driven covariate inclusion may select covariates that seem clinically unrelated to the outcome
  • Models utilized hundreds of covariates (419 to 581), making them infeasible for clinical implementation without parsimonious modeling
  • Lack of external validation in other international cohorts

Cite This Study

Bräuner et al. (2023) conducted an observational in Colorectal cancer (n=57,558). Preoperative data-driven prediction model (LASSO logistic regression) was evaluated on 30-day, 90-day, and 1-year all-cause mortality. A data-driven prediction model using preoperative data accurately predicted 30-day, 90-day, and 1-year mortality after colorectal cancer surgery with AUROCs of 0.88, 0.878, and 0.861, respectively.

synapsesocial.com/papers/6a789f5ef6749a0058eca48ahttps://doi.org/10.21203/rs.3.rs-3534294/v1
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