Urgency Index and Preoperative Index: Prediction of Anastomotic Leakage in Patients Operated For Colorectal Cancer Treatment

Abstract

Background: Several tools are available for predicting the risk of anastomotic leakage (AL) in patients undergoing colectomy for colorectal cancer (CRC) treatment. However, these prognostic indexes have limitations in applicability and efficiency.
 Aim: Developing validated, efficient and easily applicable tools to help physicians predict the risk of AL.
 Methods: From a meta-analysis and a retrospective cohort, risk factors associated with the development of AL were used to construct and validate two new indexes (Urgency Index and Preoperative Index) to predict AL risk. Sensitivity, specificity, ROC curve, accuracy, and positive and negative predictive value were calculated.
 Results: The Urgency Index indicated four variables for AL risk prediction and showed sensitivity of 81.24%, specificity of 75.8%, AUC of 0.841 (95% CI: 0.742-0.939), and accuracy of 76.24%. The Preoperative Index revealed 13 variables and showed 86.56% specificity, 50% sensitivity, 0.699 area under the ROC curve, 83.66% accuracy, 24.24% positive predictive value, and 95.27% negative predictive value.
 Conclusion: The two new indexes created for AL risk prediction in patients operated for CRC treatment present good results of specificity, accuracy and reasonable AUC values, and could be used in clinical practice.

Development and Validation of a Mobile Application for Predicting the Risk of Anastomotic Leakage in Patients Operated for the Treatment of Colorectal Cancer

“…The application is divided into two indexes, previously validated [15], one recommended for urgency because it has fewer variables (four), and another for elective surgeries, with 13 variables. The two scales are easier to use than the scale constructed by Rojas-Machado et al [6], which has many variables (23), some of which are difficult to obtain, requiring prior examinations.…”

“…The Urgency Index showed sensitivity of 81.24%, specificity of 75.8%, area under the ROC curve (AUC) of 0.841 (95% CI: 0.742-0.939) and accuracy of 76.24% [14]. Furthermore, the Preoperative Index revealed 85.56% of specificity, 50% sensitivity, 0.699 AUC, 83.66% accuracy, 24.24% positive predictive value and 95.27% negative predictive value [15]. The probability equation:…”

“…In the modeling stage, the content of the application was defined and the way in which it should be presented to the target audience. The contents are two indices for the prognosis of AL in patients operated on for the treatment of CRC: preoperative index derived from the metaanalysis [14] and the urgency index performed from a historical cohort [14,15]. The preoperative index contains 13 variables, while the urgency index has four, all of which are risk factors for the occurrence of AL.…”

“…The preoperative index contains 13 variables, while the urgency index has four, all of which are risk factors for the occurrence of AL. Both were developed and validated by this research group with the specific purpose of predicting the risk of AL in patients operated on for CRC treatment and composing the content of this application [14,15]. Below is the weight of each factor obtained through metaanalysis and the equations for obtaining the indices.…”