TY - JOUR
T1 - Surgeons’ assessment versus risk models for predicting complications of hepato-pancreato-biliary surgery (HPB-RISC): a multicenter prospective cohort study
AU - HPB-RISC Study Group
AU - Samim, Morsal
AU - Mungroop, Timothy H.
AU - AbuHilal, Mohammed
AU - Isfordink, Cas J.
AU - Molenaar, Quintus I.
AU - van der Poel, Marcel J.
AU - Armstrong, Thomas A.
AU - Takhar, Arjun S.
AU - Pearce, Neil W.
AU - Primrose, John N.
AU - Harris, Scott
AU - Verkooijen, Helena M.
AU - van Gulik, Thomas M.
AU - Hagendoorn, Jeroen
AU - Busch, Olivier R.
AU - Johnson, Colin D.
AU - Besselink, Marc G.
PY - 2018
Y1 - 2018
N2 - Background: Several studies advise the use of risk models when counseling patients for hepato-pancreato-biliary (HPB) surgery, but studies comparing these models to the surgeons’ assessment are lacking. The aim of this study was to assess whether risk prediction models outperform surgeons’ assessment for the risk of complications in HPB surgery. Methods: This prospective study included adult patients scheduled for HPB surgery in three centers in the UK and the Netherlands. Primary outcome was the rate of postoperative major complications. Surgeons assessed the risk prior to surgery while blinded for the formal risk scores. Risk prediction models were retrieved via a systematic review and risk scores were calculated. For each model, discrimination and calibration were evaluated. Results: Overall, 349 patients were included. The rate of major complications was 27% and in-hospital mortality 3%. Surgeons’ assessment resulted in an AUC of 0.64; 0.71 for liver and 0.56 for pancreas surgery (P = 0.020). The AUCs for nine existing risk prediction models ranged between 0.57 and 0.73 for liver surgery and between 0.51 and 0.57 for pancreas surgery. Conclusion: In HPB surgery, existing risk prediction models do not outperform surgeons’ assessment. Surgeons’ assessment outperforms most risk prediction models for liver surgery although both have a poor predictive performance for pancreas surgery. Registration information: REC reference number (13/SC/0135); IRAS ID (119370). Trialregister.nl: NTR4649.
AB - Background: Several studies advise the use of risk models when counseling patients for hepato-pancreato-biliary (HPB) surgery, but studies comparing these models to the surgeons’ assessment are lacking. The aim of this study was to assess whether risk prediction models outperform surgeons’ assessment for the risk of complications in HPB surgery. Methods: This prospective study included adult patients scheduled for HPB surgery in three centers in the UK and the Netherlands. Primary outcome was the rate of postoperative major complications. Surgeons assessed the risk prior to surgery while blinded for the formal risk scores. Risk prediction models were retrieved via a systematic review and risk scores were calculated. For each model, discrimination and calibration were evaluated. Results: Overall, 349 patients were included. The rate of major complications was 27% and in-hospital mortality 3%. Surgeons’ assessment resulted in an AUC of 0.64; 0.71 for liver and 0.56 for pancreas surgery (P = 0.020). The AUCs for nine existing risk prediction models ranged between 0.57 and 0.73 for liver surgery and between 0.51 and 0.57 for pancreas surgery. Conclusion: In HPB surgery, existing risk prediction models do not outperform surgeons’ assessment. Surgeons’ assessment outperforms most risk prediction models for liver surgery although both have a poor predictive performance for pancreas surgery. Registration information: REC reference number (13/SC/0135); IRAS ID (119370). Trialregister.nl: NTR4649.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85045577082&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29678364
U2 - https://doi.org/10.1016/j.hpb.2018.02.635
DO - https://doi.org/10.1016/j.hpb.2018.02.635
M3 - Article
C2 - 29678364
SN - 1365-182X
VL - 20
SP - 809
EP - 814
JO - HPB: The official journal of the International Hepato Pancreato Biliary Association
JF - HPB: The official journal of the International Hepato Pancreato Biliary Association
IS - 9
ER -