Risk Prediction Scores for Postoperative Mortality After Esophagectomy: Validation of Different Models

Abstract

None of the scores can be applied generally. A better overall predictive score or specific prediction scores for each country should be developed.

The Surgical Apgar Score in esophagectomy

“…[1][2][3] Numerous risk factors have been found to be associated with major morbidity and mortality after esophagectomy [3][4][5] ; however, previously reported risk models have been unreliable. 6,7 These studies have primarily focused on preoperative risk assessment in an effort to improve outcomes through better patient selection and to facilitate risk-stratified comparative analyses for quality assessment.…”

The Impact of Age on Morbidity and Mortality following Esophagectomy for Esophageal Cancer

“…Zingg et al 49 compared four distinct risk-assessment models for esophagectomy cohorts in Australia and Switzerland. The models included were from Philadelphia, Munich, Rotterdam, and the ASA.…”

Assessment of a scoring system for predicting complications after esophagectomy

“…Knowledge of these risk factors could assist in selection of appropriate preoperative testing for patients who are candidates for esophagectomy and could provide information regarding operative risk, especially if the relative impact of each factor was easily identified. However, attempts to develop predictive algorithms for risk have largely been unsuccessful 4 . Reasons for this include the lack of accuracy when a model developed using one data set is applied to a population of patients that differs ethnically, geographically, or temporally, differences in perioperative management that can have an important impact on acute surgical outcomes unrelated to risk factors, and the apparent lack of interest of surgeons in using risk scoring algorithms.…”

“…Identification of patients who are at increased risk for developing postoperative complications may assist in selecting patients for surgery, informing patients about their individual risk level, and managing resources for postoperative care. Although a number of centers have developed predictive systems for identifying the risk of mortality after esophagectomy, 1–3 in a recent validation effort, none of the systems was found to be applicable generally or sufficiently accurate 4 …”

“…Although a number of centers have developed predictive systems for identifying the risk of mortality after esophagectomy, 1-3 in a recent validation effort, none of the systems was found to be applicable generally or sufficiently accurate. 4 A scoring system was recently developed using data from a tertiary care medical center in the Netherlands to identify the risk of major and minor complications after esophagectomy and subsequently was validated using a data set from a separate tertiary care center in the same country. 5,6 The potential utility of this system was apparent, but concern was expressed regarding the validity of a confirmatory study performed using a patient population that was closely related geographically and ethnically to the derivation patient population.…”