Pre-Operative Nomogram to Predict Risk of Peri-Operative Mortality Following Hepatic Resections for Malignancy
Mashaal Dhir1, Smith Lynette2, Fred Ullrich2, Leiphrakpam Premila1, Quan Ly1, Aaron R. Sasson1, Chandrakanth Are*1
1Department of Surgery, Division of Surgical Oncology, Eppley Cancer Center, University of Nebraska Medical Center, Omaha. 68198, NE; 2Department of Epidemiology and Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE
INTRODUCTION: The majority of hepatic resections for malignancy are performed in older patients with major co-morbidties. There is currently no pre-operative, patient-specific method to determine the likely peri-operative mortality for each individual patient. The aim of this study was to develop a pre-operative nomogram based on the presence of co-morbdities to predict risk of peri-operative mortality following hepatic resection for malignancy.METHODS: The National Inpatient Sample database was queried to identify adult patients that underwent hepatic resection for malignancy. The pre-operative co-morbidties, identified as predictors were used and a nomogram was created with multivariate regression using the Taylor expansion method in SAS Software, SURVEYLOGISTIC Procedure. Sample A (2000- 2004) was utilized to develop the model and Sample B (2005) was utilized to validate this model. RESULTS: A total of 4405 and 1072 patients were included in Samples A and B. The overall actual observed peri-operative mortality rate for Samples A and B was 4.2% and 3.5% respectively. The decile- based calibration plot for Sample A revealed excellent agreement between the observed probabilities and nomogram predicted probabilities. Similarly, the quartile-based calibration plot for Sample B revealed good agreement between the observed and predicted probabilities. The accuracy of the nomogram was further reinforced by a good concordance index of 0.80 with a 95% confidence interval of 0.73 to 0.86. CONCLUSION: This pre-operative nomogram has been shown to accurately predict the risk of peri-operative mortality following hepatic resection for malignancy.
Back to Program
