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INTRODUCTION: Surgery remains one of the major treatment options available to patients with gastric cancer; therefore operative mortality is an important consideration. 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-morbidities to predict risk of peri-operative mortality following gastric resection for malignancy.METHODS: The National Inpatient Sample database was queried to identify adult patients that underwent gastric resection for malignancy. The pre-operative co-morbidities, identified as predictors were used and a nomogram was created with multivariate regression using the Taylor expansion method in SAS Software, SURVEYLOGISTIC Procedure. A Training set (Years 1993, 1996, 1997, 1999, 2000, 2002, 2004 and 2005) was utilized to develop the model and a validation set (Years 1994-95, 1998, 2001 and 2003) was utilized to validate this model. RESULTS: A total of 14,235 and 9,404 patients were included in the training set and validation set, respectively. The overall actual observed peri-operative mortality rate for training set and validation set were 5.9% and 6.7%, respectively. Figure 1 depicts the constructed nomogram. The decile- based calibration plots for the training and validation sets revealed a good agreement between the observed probabilities and nomogram predicted probabilities. The accuracy of the nomogram was further reinforced by a concordance index of 0.75 with 95% confidence interval of 0.73 to 0.77 calculated using the validation set. CONCLUSION: This pre-operative nomogram has been shown to accurately predict the risk of peri-operative mortality following gastric resections for malignancy.

Pre-operative nomogram to predict peri-operative mortality following gastric resections for malignancy