Colorectal preOperative Surgical Score (CrOSS) for mortality in major colorectal surgery

Abstract

Background: Colorectal surgery carries a significant mortality risk, with reported rates of 1-6% for elective surgery and up to 22% in the emergency setting. Both clinicians and patients will benefit from being able to predict the likelihood of death before surgery. Recently, we have described and validated two risk stratification models for colorectal surgery, the Barwon Health 2012 and Association Française de Chirurgie models. However, these models are not suitable for assessment at patient's bedside. The purpose of this study is to develop a simplified preoperative model capable of predicting mortality following colorectal surgery. Methods:The new model is termed Colorectal preOperative Surgical Score (CrOSS). The development and internal validation of CrOSS was performed using a prospectively maintained colorectal database. External validation was performed using retrospective data. Univariate and multivariate analyses were performed in model development. Calibration and discrimination were used for model validation. Results: There were 474 and 389 consecutive colorectal surgeries at Geelong Hospital and Western Hospital. Overall mortality rates were 5.16% and 1.03%, respectively. Significant predictors for mortality were as follows: age ≥70, urgent operation, albumin ≤30 g/L and congestive heart failure (receiver operating characteristic (ROC) = 0.870, calibration P-value = 0.937). The predicted risk of mortality was stratified according to the risk profile of 0.39-66.51%. When validated externally, CrOSS predicted mortality accurately (ROC = 0.847, calibration P-value = 0.199). Conclusions: A robust and simple preoperative model has been created to riskstratify patients for colorectal surgery. This was successfully validated at another tertiary hospital.

CCR-CARESS score for predicting operative mortality in patients with colorectal cancer

“…However, some of the variables included (such as preoperative hypoalbuminaemia and functional status) were not available routinely or determined before the intervention in the present study context, hindering application of the score for predictive purposes. Likewise, another predictive model with high discriminatory power (AUC 0·870) for operative mortality in colorectal surgery, the Colorectal preOperative Surgical Score (CrOSS), devised by Kong et al . in two hospitals, also includes preoperative hypoalbuminaemia among the four variables collected.…”

Predictors of Morbidity and Mortality After Surgery for Intestinal Perforation

“…Serum albumin is a widely accepted indicator of nutritional status [26], although some controversy exists because albumin is a negative acute-phase reactant and hypoalbuminemia is a sign of systemic inflammation [27]. However, serum albumin is a better prognostic indicator than other scoring systems because it indicates protein-energy malnu-trition resulting from the stress of illness, injury, or infection [28], all of which are associated with significantly increased risk of morbidity and mortality [293031]. Serum albumin is also well known to be associated with surgical outcomes.…”

Systematic review of the feasibility of laparoscopic reoperation for early postoperative complications following colorectal surgery

“…The conventional open approach to colorectal surgical emergencies or reoperative surgery is associated with wound complications, organ failure and the requirement for ICU admission. If the patient's initial procedure was laparoscopic, the benefits of minimal access would be negated by the subsequent physiological insult of a laparotomy.…”