Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery
Preoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patie...
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| Veröffentlicht in: | European journal of surgical oncology 2024-06, Vol.50 (6), p.108338-108338, Article 108338 |
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| creator | Cuijpers, Anne C.M. Lubbers, Tim Dronkers, Jaap J. Heldens, Aniek F.J.M. Zoethout, Siebrand B. Leistra, Duncan van Kuijk, Sander M.J. van Meeteren, Nico L.U. Stassen, Laurents P.S. Bongers, Bart C. |
| description | Preoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patients with and without an increased risk for 1) postoperative complications and 2) a prolonged time to in-hospital recovery of physical functioning after elective colorectal cancer (CRC) surgery.
Models were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance.
Aerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598–0.733) and 0.722 (0.651–0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories ( |
| doi_str_mv | 10.1016/j.ejso.2024.108338 |
| format | Article |
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Models were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance.
Aerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598–0.733) and 0.722 (0.651–0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories (<40 %).
Both models identify patients with and without an increased risk of complications or a prolonged time to in-hospital physical recovery. They might be used for improving patient-tailored preoperative risk assessment and targeted and cost-effective application of prehabilitation interventions.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2024.108338</identifier><identifier>PMID: 38728861</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aerobic fitness ; Age Factors ; Aged ; Body Mass Index ; Colorectal cancer ; Colorectal Neoplasms - surgery ; Complication risk ; Elective Surgical Procedures ; Female ; Humans ; Male ; Middle Aged ; Physical Fitness ; Postoperative Complications - epidemiology ; Prediction model ; Prehabilitation ; Preoperative Exercise ; Preoperative Period ; Prospective Studies ; Recovery of Function ; Recovery of physical functioning ; Risk Assessment - methods</subject><ispartof>European journal of surgical oncology, 2024-06, Vol.50 (6), p.108338-108338, Article 108338</ispartof><rights>2024 The Authors</rights><rights>2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c351t-33a91e5c6745655e982b0a89a94df31cc5d2f1a0530d6ea53e574c51a3a0a9f03</cites><orcidid>0000-0002-0335-0415 ; 0000-0001-6338-9322 ; 0000-0002-1948-9788</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0748798324003901$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38728861$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cuijpers, Anne C.M.</creatorcontrib><creatorcontrib>Lubbers, Tim</creatorcontrib><creatorcontrib>Dronkers, Jaap J.</creatorcontrib><creatorcontrib>Heldens, Aniek F.J.M.</creatorcontrib><creatorcontrib>Zoethout, Siebrand B.</creatorcontrib><creatorcontrib>Leistra, Duncan</creatorcontrib><creatorcontrib>van Kuijk, Sander M.J.</creatorcontrib><creatorcontrib>van Meeteren, Nico L.U.</creatorcontrib><creatorcontrib>Stassen, Laurents P.S.</creatorcontrib><creatorcontrib>Bongers, Bart C.</creatorcontrib><title>Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>Preoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patients with and without an increased risk for 1) postoperative complications and 2) a prolonged time to in-hospital recovery of physical functioning after elective colorectal cancer (CRC) surgery.
Models were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance.
Aerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598–0.733) and 0.722 (0.651–0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories (<40 %).
Both models identify patients with and without an increased risk of complications or a prolonged time to in-hospital physical recovery. They might be used for improving patient-tailored preoperative risk assessment and targeted and cost-effective application of prehabilitation interventions.</description><subject>Aerobic fitness</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Body Mass Index</subject><subject>Colorectal cancer</subject><subject>Colorectal Neoplasms - surgery</subject><subject>Complication risk</subject><subject>Elective Surgical Procedures</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Physical Fitness</subject><subject>Postoperative Complications - epidemiology</subject><subject>Prediction model</subject><subject>Prehabilitation</subject><subject>Preoperative Exercise</subject><subject>Preoperative Period</subject><subject>Prospective Studies</subject><subject>Recovery of Function</subject><subject>Recovery of physical functioning</subject><subject>Risk Assessment - methods</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuO1DAQRS0EYpqBH2CBvGSTxo7beUhs0AwvaSQ2sLaqy5XBLccOdtJivpGfwiEDiA0r2-Vzb5XqMvZcir0Usnl12tMpx30t6kMpdEp1D9hOalVXtdTtQ7YT7aGr2r5TF-xJzichRK_a_jG7UF1bd10jd-zHNZ3Jx2mkMHMIltP3mVIAz8_gnYXZxcDjwKdEcaJU3mfi6F1wWJhStQ5_MWO05DMfYuJTzPNfOC4zxpEydwH9Yl24_dcMKMWjQz64OVBeMT6VnzJP5jBNKQJ-XUXkCbfu0cdU7qU_QkBKPC_pltLdU_ZoAJ_p2f15yb68e_v56kN18-n9x6s3NxUqLedKKeglaWzag260pr6rjwK6HvqDHZRE1LYeJAithG0ItCLdHlBLUCCgH4S6ZC833zLct4XybEaXkbyHQHHJRhVp3-qm1QWtNxRTzDnRYKbkRkh3RgqzhmhOZg3RrCGaLcQienHvvxxHsn8kv1MrwOsNKBuns6NkMpaFYQljXYyx0f3P_yddXrWJ</recordid><startdate>202406</startdate><enddate>202406</enddate><creator>Cuijpers, Anne C.M.</creator><creator>Lubbers, Tim</creator><creator>Dronkers, Jaap J.</creator><creator>Heldens, Aniek F.J.M.</creator><creator>Zoethout, Siebrand B.</creator><creator>Leistra, Duncan</creator><creator>van Kuijk, Sander M.J.</creator><creator>van Meeteren, Nico L.U.</creator><creator>Stassen, Laurents P.S.</creator><creator>Bongers, Bart C.</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0335-0415</orcidid><orcidid>https://orcid.org/0000-0001-6338-9322</orcidid><orcidid>https://orcid.org/0000-0002-1948-9788</orcidid></search><sort><creationdate>202406</creationdate><title>Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery</title><author>Cuijpers, Anne C.M. ; Lubbers, Tim ; Dronkers, Jaap J. ; Heldens, Aniek F.J.M. ; Zoethout, Siebrand B. ; Leistra, Duncan ; van Kuijk, Sander M.J. ; van Meeteren, Nico L.U. ; Stassen, Laurents P.S. ; Bongers, Bart C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c351t-33a91e5c6745655e982b0a89a94df31cc5d2f1a0530d6ea53e574c51a3a0a9f03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aerobic fitness</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Body Mass Index</topic><topic>Colorectal cancer</topic><topic>Colorectal Neoplasms - surgery</topic><topic>Complication risk</topic><topic>Elective Surgical Procedures</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Physical Fitness</topic><topic>Postoperative Complications - epidemiology</topic><topic>Prediction model</topic><topic>Prehabilitation</topic><topic>Preoperative Exercise</topic><topic>Preoperative Period</topic><topic>Prospective Studies</topic><topic>Recovery of Function</topic><topic>Recovery of physical functioning</topic><topic>Risk Assessment - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cuijpers, Anne C.M.</creatorcontrib><creatorcontrib>Lubbers, Tim</creatorcontrib><creatorcontrib>Dronkers, Jaap J.</creatorcontrib><creatorcontrib>Heldens, Aniek F.J.M.</creatorcontrib><creatorcontrib>Zoethout, Siebrand B.</creatorcontrib><creatorcontrib>Leistra, Duncan</creatorcontrib><creatorcontrib>van Kuijk, Sander M.J.</creatorcontrib><creatorcontrib>van Meeteren, Nico L.U.</creatorcontrib><creatorcontrib>Stassen, Laurents P.S.</creatorcontrib><creatorcontrib>Bongers, Bart C.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cuijpers, Anne C.M.</au><au>Lubbers, Tim</au><au>Dronkers, Jaap J.</au><au>Heldens, Aniek F.J.M.</au><au>Zoethout, Siebrand B.</au><au>Leistra, Duncan</au><au>van Kuijk, Sander M.J.</au><au>van Meeteren, Nico L.U.</au><au>Stassen, Laurents P.S.</au><au>Bongers, Bart C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2024-06</date><risdate>2024</risdate><volume>50</volume><issue>6</issue><spage>108338</spage><epage>108338</epage><pages>108338-108338</pages><artnum>108338</artnum><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Preoperative aerobic fitness is associated with postoperative outcomes after elective colorectal cancer (CRC) surgery. This study aimed to develop and externally validate two clinical prediction models incorporating a practical test to assess preoperative aerobic fitness to distinguish between patients with and without an increased risk for 1) postoperative complications and 2) a prolonged time to in-hospital recovery of physical functioning after elective colorectal cancer (CRC) surgery.
Models were developed using prospective data from 256 patients and externally validated using prospective data of 291 patients. Postoperative complications were classified according to Clavien-Dindo. The modified Iowa level of assistance scale (mILAS) was used to determine time to postoperative in-hospital physical recovery. Aerobic fitness, age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, neoadjuvant treatment, surgical approach, tumour location, and preoperative haemoglobin level were potential predictors. Areas under the curve (AUC), calibration plots, and Hosmer-Lemeshow tests evaluated predictive performance.
Aerobic fitness, sex, age, ASA, tumour location, and surgical approach were included in the final models. External validation of the model for complications and postoperative recovery presented moderate to fair discrimination (AUC 0.666 (0.598–0.733) and 0.722 (0.651–0.794), respectively) and good calibration. High sensitivity and high negative predictive values were observed in the lower predicted risk categories (<40 %).
Both models identify patients with and without an increased risk of complications or a prolonged time to in-hospital physical recovery. They might be used for improving patient-tailored preoperative risk assessment and targeted and cost-effective application of prehabilitation interventions.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>38728861</pmid><doi>10.1016/j.ejso.2024.108338</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-0335-0415</orcidid><orcidid>https://orcid.org/0000-0001-6338-9322</orcidid><orcidid>https://orcid.org/0000-0002-1948-9788</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of surgical oncology, 2024-06, Vol.50 (6), p.108338-108338, Article 108338 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aerobic fitness Age Factors Aged Body Mass Index Colorectal cancer Colorectal Neoplasms - surgery Complication risk Elective Surgical Procedures Female Humans Male Middle Aged Physical Fitness Postoperative Complications - epidemiology Prediction model Prehabilitation Preoperative Exercise Preoperative Period Prospective Studies Recovery of Function Recovery of physical functioning Risk Assessment - methods |
| title | Development and external validation of preoperative clinical prediction models for postoperative outcomes including preoperative aerobic fitness in patients approaching elective colorectal cancer surgery |
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