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A Practical Mortality Risk Score for Emergent Colectomy

Kermani, Reza M.D.1; Coury, Joseph J. Jr M.D.1; Dao, Haisar M.D.1; Lee, Justin H. M.D.1; Miller, Peter E. M.D.1; Yee, Darrick Ed.M.2; Contant, Charles Ph.D.3; Hackford, Alan W. M.D.1

Diseases of the Colon & Rectum: April 2013 - Volume 56 - Issue 4 - p 467–474
doi: 10.1097/DCR.0b013e31827d0f93
Original Contribution: Benign Colorectal Disease

BACKGROUND: Critically ill patients requiring emergent colectomy have significant mortality risk.

OBJECTIVE: A national administrative database was used to compose a simple scoring scheme for predicting in-hospital mortality risk.

DESIGN: The 2007 to 2009 Nationwide Inpatient Sample was queried to identify patients requiring nonelective colectomy. Multivariable binary logistic regression analysis was used to identify predictors that increased mortality. Each predictor was given a point value, based on the corresponding logit, the sum of which constituted a risk score. The scoring system was tested by using k-partitions cross-validation.

SETTINGS: This study is based on database analysis.

PATIENTS: A total of 338,348 cases were identified. Mean age was 64, and 53% of the patients were women.

MAIN OUTCOME MEASURES: The primary outcomes measured were mortality and risk score development.

RESULTS: The overall mortality risk was 9%. Regression analysis identified the following risk factors and assigned points: acute renal failure (6), hemodialysis (6), age >65 (4), peripheral vascular disease (4), myocardial infarction (4), chronic obstructive pulmonary disease (2), cardiac arrhythmia (1), and congestive heart failure (1). The maximum score observed was 26 (of a possible 28), which corresponded to 100% mortality. Receiver operator characteristic analysis showed an area under the curve of 0.81.

LIMITATIONS: This study was limited because of its retrospective nature, and because it used database data with variability in coding among participating institutions.

CONCLUSIONS: With the use of a simple 8-variable scoring system, inpatient mortality estimates can be made for patients requiring emergent colectomy. When used judiciously, it can be used as a tool when counseling patients and family both before and after surgery.

1 Department of Surgery, Steward St. Elizabeth’s Medical Center, Boston, Massachusetts

2 Harvard Graduate School of Education, Cambridge, Massachusetts

3 Tufts Clinical and Translational Science Institute, Boston, Massachusetts

Financial Disclosures: None reported.

Presented at the meeting of New England Society of Colorectal Surgeons, Newport, RI, May 18 to 20, 2012.

Correspondence: Reza Kermani, M.D., Steward St. Elizabeth’s Medical Center, Surgical Education, 736 Cambridge St, CMP-2, Boston, MA 02135. E-mail: reza.kermani@tufts.edu

© The ASCRS 2013