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External validation of a prognostic model of preoperative risk factors for failure of restorative proctocolectomy.

External validation of a prognostic model of preoperative risk factors for failure of restorative proctocolectomy.

Authors :
Sahami S
Bartels SA
D'Hoore A
Young Fadok T
Tanis PJ
de Buck van Overstraeten A
Wolthuis AM
Buskens CJ
Bemelman WA
Source :
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland [Colorectal Dis] 2017 Feb; Vol. 19 (2), pp. 181-187.
Publication Year :
2017

Abstract

Aim: The Cleveland Clinic has proposed a prognostic model of preoperative risk factors for failure of restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis. The model incorporates four predictive variables: completion proctectomy, handsewn anastomosis, diabetes mellitus and Crohn's disease. The aim of the present study was to perform an external validation of this model in a new cohort of patients who had RPC.<br />Method: Validation was performed in a multicentre cohort of 747 consecutive patients who had an RPC between 1990 and 2015 in three tertiary-care facilities, using a Kaplan-Meier survival analysis and Cox regression analysis. The performance of the model was expressed using the Harrell concordance error rate. The primary outcome measure was pouch survival with maintenance of anal function.<br />Results: During the study period, 45 (6.0%) patients experienced failure at a median interval of 31 months (interquartile range 9-82 months) from the original RPC. Multivariable analysis showed handsewn anastomosis to be the only significant independent predictor. The Harrell concordance error rate was 0.42, indicating poor performance. Anastomotic leakage and Crohn's disease of the pouch were strong postoperative predictors for pouch failure and showed a significant difference in pouch survival after 10 years (P < 0.001).<br />Conclusion: The poor performance of the Cleveland Clinic prognostic model makes it unsuitable for daily clinical practice. Handsewn anastomosis was associated with pouch failure in our cohort with relatively few events. A prediction model for anastomotic leakage or Crohn's disease of the pouch may be a better solution since these variables are strongly associated with pouch failure.<br /> (Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.)

Details

Language :
English
ISSN :
1463-1318
Volume :
19
Issue :
2
Database :
MEDLINE
Journal :
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
Publication Type :
Academic Journal
Accession number :
27315787
Full Text :
https://doi.org/10.1111/codi.13414