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International Journal of Colorectal Disease

Published in:

01-10-2017 | Original Article

The DGAV risk calculator: development and validation of statistical models for a web-based instrument predicting complications of colorectal cancer surgery

Authors: Alexander Crispin, Carsten Klinger, Anna Rieger, Brigitte Strahwald, Kai Lehmann, Heinz-Johannes Buhr, Ulrich Mansmann

Published in: International Journal of Colorectal Disease | Issue 10/2017

Abstract

Purpose

The purpose of this study is to provide a web-based calculator predicting complication probabilities of patients undergoing colorectal cancer (CRC) surgery in Germany.

Methods

Analyses were based on records of first-time CRC surgery between 2010 and February 2017, documented in the database of the Study, Documentation, and Quality Center (StuDoQ) of the Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), a registry of CRC surgery in hospitals throughout Germany, covering demography, medical history, tumor features, comorbidity, behavioral risk factors, surgical procedures, and outcomes. Using logistic ridge regression, separate models were developed in learning samples of 6729 colon and 4381 rectum cancer patients and evaluated in validation samples of sizes 2407 and 1287. Discrimination was assessed using c statistics. Calibration was examined graphically by plotting observed versus predicted complication probabilities and numerically using Brier scores.

Results

We report validation results regarding 15 outcomes such as any major complication, surgical site infection, anastomotic leakage, bladder voiding disturbance after rectal surgery, abdominal wall dehiscence, various internistic complications, 30-day readmission, 30-day reoperation rate, and 30-day mortality. When applied to the validation samples, c statistics ranged between 0.60 for anastomosis leakage and 0.85 for mortality after rectum cancer surgery. Brier scores ranged from 0.003 to 0.127.

Conclusions

While most models showed satisfactory discrimination and calibration, this does not preclude overly optimistic or pessimistic individual predictions. To avoid misinterpretation, one has to understand the basic principles of risk calculation and risk communication. An e-learning tool outlining the appropriate use of the risk calculator is provided.

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Title: The DGAV risk calculator: development and validation of statistical models for a web-based instrument predicting complications of colorectal cancer surgery
Authors: Alexander Crispin
Carsten Klinger
Anna Rieger
Brigitte Strahwald
Kai Lehmann
Heinz-Johannes Buhr
Ulrich Mansmann
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Colorectal Disease / Issue 10/2017
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI: https://doi.org/10.1007/s00384-017-2869-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The DGAV risk calculator: development and validation of statistical models for a web-based instrument predicting complications of colorectal cancer surgery

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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