The following is the summary of “Improved Preoperative Risk Assessment Tools Are Needed to Guide Informed Decision Making before Esophagectomy” published in the January 2023 issue of Surgery by Gray, et al.
With this study, researchers aimed to compare the efficacy of two widely-used prediction models for postoperative morbidity in patients undergoing open and minimally invasive esophagectomy. Extensive postoperative problems are common for patients who have experienced an esophagectomy. Therefore, for rational choice, it is crucial to have a precise risk assessment of this group. Procedures Investigators used a prospectively kept database to identify individuals who had esophagectomy between January 2016 and June 2018. The Surgical Risk Calculator (SRC) developed by the American College of Surgeons and the 5-factor frailty index developed from data collected by the National Surgical Quality Improvement Program were used to predict the likelihood of adverse outcomes following surgery. The effectiveness was measured with the help of a C-index and calibration curves.
About 240 consecutive patients were used for this study. The Ivor-Lewis esophagectomy was used for 85 percent of the patients. Overall, 39% of patients experienced complications, with 33% experiencing significant complications. Calibration curves demonstrated an overall underestimate, and the SRC failed to detect complication risk across the board (C-index, 0.553), in patients undergoing open esophagectomy (C-index, 0.569), or in patients receiving minimally invasive esophagectomy (C-index, 0.542). Discrimination by the SRC ranged from low for reoperation (C-index, 0.533) to high for discharge to a facility other than home (C-index, 0.728).
Frailty index C-index was 0.513 for distinguishing any complication, 0.523 for discriminating a significant complication, and 0.559 for readmission. Study group concludes that the SRC and frailty index are not useful predictors of postoperative problems following esophagectomy. Procedure-specific risk assessment tools are required to facilitate informed, shared decision-making between patients and doctors in this high-risk population.
