TY - JOUR
T1 - A Preoperative Nomogram to Predict the Risk of Perioperative Mortality Following Gastric Resections for Malignancy
AU - Dhir, Mashaal
AU - Smith, Lynette M.
AU - Ullrich, Fred
AU - Leiphrakpam, Premila D.
AU - Ly, Quan P.
AU - Sasson, Aaron R.
AU - Are, Chandrakanth
N1 - Funding Information:
Data were obtained from the Nationwide Inpatient Sample (NIS), a database developed as part of Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality (http://www.hcup-us.ahrq.gov/nisover view.jsp). The NIS is designed to approximate a 20 % sample of the US community hospitals. In 2005, the NIS data contained discharge data from 1,054 hospitals located in 37 states. Data for the current study were compiled from the 1993-2005 versions of the NIS. All patients discharged with an International Classification of Diseases, Ninth Revision, Clinical Modification primary procedure code for total gastrectomy or partial gastrectomy (total gastrectomy codes: 43.9, 43.91, and 43.99, partial gastrectomy codes: 43.5, 43.6, 43.7, 43.81, 43.89) were included in the study. Primary diagnosis codes for the malignant neoplasms of the stomach including codes 151.0, 151.1, 151.2, 151.3, 151.4, 151.5, 151.6, 151.8, 151.9, and 230.2 were included in the current study. Diagnosis code 209.23 which represents the malignant carcinoid tumors of the stomach was not available until 2008 and was therefore excluded from the current study. The analysis was limited to individuals who were 18 years of age or older. NIS prevents disclosure of numbers if the number of observations in a cell is less than ten.
PY - 2012/11
Y1 - 2012/11
N2 - Introduction: Surgery remains one of the major treatment options available to patients with gastric cancer. The aim of this study was to develop a preoperative nomogram based on the presence of comorbidities to predict the risk of perioperative mortality following gastric resections for malignancy. Methods: The Nationwide Inpatient Sample (NIS) database was used to create a nomogram using SAS software. The training set (years 1993, 1996-97, 1999-2000, 2002, 2004-05) was used to develop the model which was further validated using the validation set (years 1994-95, 1998, 2001, and 2003). Results: A total of 14,235 and 9,404 patients were included in the training and validation sets, respectively, with overall actual observed perioperative mortality rates of 5.9 % and 6.6 %, respectively. The decile-based calibration plots for the training and validation sets revealed a good agreement between the observed and nomogram-predicted probabilities. The accuracy of the nomogram was further reinforced by a concordance index of 0.75 (95 % confidence interval 0.73 to 0.77) which was calculated using the validation set. Conclusion: This preoperative nomogram may accurately predict the risk of perioperative mortality following gastric resections for malignancy and may be used as an adjunctive clinical tool in the preoperative counseling of these patients.
AB - Introduction: Surgery remains one of the major treatment options available to patients with gastric cancer. The aim of this study was to develop a preoperative nomogram based on the presence of comorbidities to predict the risk of perioperative mortality following gastric resections for malignancy. Methods: The Nationwide Inpatient Sample (NIS) database was used to create a nomogram using SAS software. The training set (years 1993, 1996-97, 1999-2000, 2002, 2004-05) was used to develop the model which was further validated using the validation set (years 1994-95, 1998, 2001, and 2003). Results: A total of 14,235 and 9,404 patients were included in the training and validation sets, respectively, with overall actual observed perioperative mortality rates of 5.9 % and 6.6 %, respectively. The decile-based calibration plots for the training and validation sets revealed a good agreement between the observed and nomogram-predicted probabilities. The accuracy of the nomogram was further reinforced by a concordance index of 0.75 (95 % confidence interval 0.73 to 0.77) which was calculated using the validation set. Conclusion: This preoperative nomogram may accurately predict the risk of perioperative mortality following gastric resections for malignancy and may be used as an adjunctive clinical tool in the preoperative counseling of these patients.
KW - Gastric resections
KW - Malignancy
KW - Nomogram
KW - Perioperative mortality
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U2 - 10.1007/s11605-012-2010-7
DO - 10.1007/s11605-012-2010-7
M3 - Article
C2 - 22948837
AN - SCOPUS:84869128970
SN - 1091-255X
VL - 16
SP - 2026
EP - 2036
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 11
ER -