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Improved Preoperative Risk Assessment Tools Are Needed to Guide Informed Decision Making before Esophagectomy.

Katherine D Gray1,2, Tamar B Nobel2, Meier Hsu3

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Common risk calculators like the Surgical Risk Calculator (SRC) and frailty index do not accurately predict complications after esophagectomy. New, procedure-specific tools are needed for better patient risk assessment.

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Area of Science:

  • Surgical oncology
  • Outcomes research
  • Health informatics

Background:

  • Esophagectomy patients face significant postoperative complication risks.
  • Accurate risk assessment is crucial for informed patient-physician decision-making.

Purpose of the Study:

  • To evaluate the predictive performance of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (SRC) and a frailty index for postoperative morbidity in esophagectomy patients.
  • To compare the accuracy of these models in open versus minimally invasive esophagectomy.

Main Methods:

  • Analysis of 240 esophagectomy patients (Jan 2016-June 2018) from a prospectively maintained database.
  • Calculation of predicted morbidity using the SRC and a 5-factor frailty index.
  • Performance evaluation via concordance index (C-index) and calibration curves.

Main Results:

  • Observed overall and serious complication rates were 39% and 33%, respectively.
  • The SRC demonstrated poor discrimination for overall complications (C-index < 0.57) and underestimation.
  • The frailty index also showed limited predictive ability for complications and readmission (C-index < 0.56).

Conclusions:

  • Current risk prediction models (SRC and frailty index) are inadequate for esophagectomy.
  • Development of procedure-specific risk assessment tools is necessary.
  • Improved tools will enhance shared decision-making for high-risk esophagectomy patients.