Development and internal validation of time-to-event risk prediction models for major medical complications within 30 days after elective colectomy.

Autor: Ke JXC; Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, British Columbia, Canada., Jen TTH; Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, British Columbia, Canada., Gao S; Department of Statistics, Faculty of Science, The University of British Columbia, Vancouver, British Columbia, Canada., Ngo L; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America.; Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America., Wu L; Department of Statistics, Faculty of Science, The University of British Columbia, Vancouver, British Columbia, Canada., Flexman AM; Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, British Columbia, Canada., Schwarz SKW; Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, British Columbia, Canada., Brown CJ; Department of Surgery, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; Department of Surgery, St. Paul's Hospital/Providence Health Care, Vancouver, British Columbia, Canada., Görges M; Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.; BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Dec 02; Vol. 19 (12), pp. e0314526. Date of Electronic Publication: 2024 Dec 02 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0314526
Abstrakt: Background: Patients undergoing colectomy are at risk of numerous major complications. However, existing binary risk stratification models do not predict when a patient may be at highest risks of each complication. Accurate prediction of the timing of complications facilitates targeted, resource-efficient monitoring. We sought to develop and internally validate Cox proportional hazards models to predict time-to-complication of major complications within 30 days after elective colectomy.
Methods: We studied a retrospective cohort from the multicentered American College of Surgeons National Surgical Quality Improvement Program procedure-targeted colectomy dataset. Patients aged 18 years or above, who underwent elective colectomy between January 1, 2014 and December 31, 2019 were included. A priori candidate predictors were selected based on variable availability, literature review, and multidisciplinary team consensus. Outcomes were mortality, hospital readmission, myocardial infarction, cerebral vascular events, pneumonia, venous thromboembolism, acute renal failure, and sepsis or septic shock within 30 days after surgery.
Results: The cohort consisted of 132145 patients (mean ± SD age, 61 ± 15 years; 52% females). Complication rates ranged between 0.3% (n = 383) for cardiac arrest and acute renal failure to 5.3% (n = 6986) for bleeding requiring transfusion, with readmission rate of 8.6% (n = 11415). We observed distinct temporal patterns for each complication: the median [quartiles] postoperative day of complication diagnosis ranged from 1 [0, 2] days for bleeding requiring transfusion to 12 [6, 18] days for venous thromboembolism. Models for mortality, myocardial infarction, pneumonia, and renal failure showed good discrimination with a concordance > 0.8, while models for readmission, venous thromboembolism, and sepsis performed poorly with a concordance of 0.6 to 0.7. Models exhibited good calibration but ranges were limited to low probability areas.
Conclusions: We developed and internally validated time-to-event prediction models for complications after elective colectomy. Once further validated, the models can facilitate tailored monitoring of high risk patients during high risk periods.
Trial Registration: Clinicaltrials.gov (NCT05150548; Principal Investigator: Janny Xue Chen Ke, M.D., M.Sc., F.R.C.P.C.; initial posting: November 25, 2021).
Competing Interests: We have read the journal’s policy and the authors of this manuscript have the following declarations. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The funders below did not contribute to this project, and this project has no relation with the projects below. Dr. Janny Ke received salary support as the Clinical Data Lead, St. Paul’s Hospital, Vancouver, BC, Canada, for the project “Reducing Opioid Use for Pain Management” DIGITAL, Canada’s Global Innovation Cluster for digital technologies, and a project consortium from commercial funders (Careteam Technologies Inc, Thrive Health Inc, Excelar Technologies (Connected Displays Inc), Providence Health Care Ventures Inc, and Xerus Inc [now part of Excelar]). Dr. Ke provided paid consulting for commercial funder Careflow Technologies (Connected Displays Inc), funded via Providence Health Care Ventures (Vancouver, BC, Canada). Dr. Ke receives research and salary support for Project "Continuous Connected Patient Care", funded by DIGITAL and a project consortium of commercial funders (Medtronic Canada ULC, Cloud Diagnostics Canada ULC, Excelar Technologies [Connected Displays Inc.], Providence Health Care Ventures Inc, 3D Bridge Solutions Inc, and FluidAI [NERv Technology Inc.]). Dr. Stephan K. W. Schwarz is the Editor-in-Chief of the Canadian Journal of Anesthesia and holds the Dr. Jean Templeton Hugill Chair in Anesthesia, supported by the Dr. Jean Templeton Hugill Endowment for Anesthesia Memorial Fund at The University of British Columbia (Vancouver, BC, Canada). He gratefully receives academic support from the Department of Anesthesia, St. Paul’s Hospital/Providence Health Care (Vancouver, BC, Canada). Dr. Matthias Görges holds a Michael Smith Health Research BC scholar award, is supported by a 2020 BC Children’s Hospital Research Institute External Salary Recognition Award, and was the research lead for the “Reducing Opioid Use for Pain Management” DIGITAL project consortium (see above for commercial funders). Dr. Alana Flexman declares consultant fees from Wolter Kluwer (Up To Date), research salary support from Michael Smith Health Research BC and operational research support from commercial funder Eisai, Inc. There is no other employment, consultancy, patents, products in development, or marketed products from commercial entities.
(Copyright: © 2024 Ke et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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