TY - JOUR
T1 - Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery
AU - Cuijpers, Anne C.M.
AU - Lubbers, Tim
AU - Dronkers, Jaap J.
AU - Heldens, Aniek F.J.M.
AU - Zoethout, Siebrand B.
AU - Leistra, Duncan
AU - van Kuijk, Sander M.J.
AU - van Meeteren, Nico L.U.
AU - Stassen, Laurents P.S.
AU - Bongers, Bart C.
N1 - Funding Information:
This study is part of a larger project, the public-private partnership project (PROCLINA), which is co-funded by an unconditional research grant from MRDM (Medical Research Data Management), as well as by the Ministry of Economic Affairs by means of a PPP Allowance made available by Health\u223CHolland, Top Sector Life Sciences & Health (LSH M17073). Health\u223CHolland encourages innovative research by financially supporting public private partnerships in the life sciences and health sector, with the aim of developing sustainable and innovative products and services. The consortium has made agreements about the intellectual property (IP) related to the knowledge and products that will be developed in the project. The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.
Funding Information:
The collaboration project (PROCLINA) was co-funded by an unconditional research grant from MRDM (Medical Research Data Management), as well as by the Ministry of Economic Affairs by means of a PPP Allowance made available by Health\u223CHolland, Top Sector Life Sciences & Health (LSHM17073), to stimulate public-private partnerships. The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. The authors declare no conflict of interest.
Publisher Copyright:
© 2024 The Authors
PY - 2024/6/1
Y1 - 2024/6/1
N2 - Introduction: Preoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patients with and without an increased risk for 1) postoperative complications and 2) a prolonged time to in-hospital recovery of physical functioning after elective colorectal cancer (CRC) surgery. Materials and methods: Models were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance. Results: Aerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598–0.733) and 0.722 (0.651–0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories (<40 %). Conclusion: Both models identify patients with and without an increased risk of complications or a prolonged time to in-hospital physical recovery. They might be used for improving patient-tailored preoperative risk assessment and targeted and cost-effective application of prehabilitation interventions.
AB - Introduction: Preoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patients with and without an increased risk for 1) postoperative complications and 2) a prolonged time to in-hospital recovery of physical functioning after elective colorectal cancer (CRC) surgery. Materials and methods: Models were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance. Results: Aerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598–0.733) and 0.722 (0.651–0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories (<40 %). Conclusion: Both models identify patients with and without an increased risk of complications or a prolonged time to in-hospital physical recovery. They might be used for improving patient-tailored preoperative risk assessment and targeted and cost-effective application of prehabilitation interventions.
KW - Aerobic fitness
KW - Colorectal cancer
KW - Complication risk
KW - Prediction model
KW - Prehabilitation
KW - Recovery of physical functioning
U2 - 10.1016/j.ejso.2024.108338
DO - 10.1016/j.ejso.2024.108338
M3 - Article
SN - 0748-7983
VL - 50
JO - European Journal of Surgical Oncology
JF - European Journal of Surgical Oncology
IS - 6
M1 - 108338
ER -