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Surgeons' assessment versus risk models for predicting complications of hepato-pancreato-biliary surgery (HPB-RISC): a multicenter prospective cohort study

Surgeons' assessment versus risk models for predicting complications of hepato-pancreato-biliary surgery (HPB-RISC): a multicenter prospective cohort study
Surgeons' assessment versus risk models for predicting complications of hepato-pancreato-biliary surgery (HPB-RISC): a multicenter prospective cohort study

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.

Journal Article
1365-182X
809-814
Samim, Morsal
1f6f2dd8-65c7-4abd-bdb4-5121d4b6fe6d
Mungroop, Timothy H.
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Abuhilal, Mohammed Abuhilal
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Isfordink, Cas J.
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Molenaar, Quintus I.
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van der Poel, Marcel J.
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Armstrong, Thomas A.
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Takhar, Arjun S.
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Pearce, Neil W.
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Primrose, John N.
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Harris, Scott
19ea097b-df15-4f0f-be19-8ac42c190028
Verkooijen, Helena M.
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van Gulik, Thomas M.
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Hagendoorn, Jeroen
a6eff1d2-4f0a-439f-9a96-5931e3b03e0f
Busch, Olivier R.
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Johnson, Colin D.
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Besselink, Marc G.
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HPB-RISC Study Group
Samim, Morsal
1f6f2dd8-65c7-4abd-bdb4-5121d4b6fe6d
Mungroop, Timothy H.
b4a64600-0bdc-4215-95d5-f4e1148e8af4
Abuhilal, Mohammed Abuhilal
13c61242-d788-4621-9f7c-7dbd265c3a7a
Isfordink, Cas J.
f41174bd-7b64-4d92-af47-7a9800ed5f9b
Molenaar, Quintus I.
060138b9-be29-4a87-94f5-de17a6b3146d
van der Poel, Marcel J.
2fb8ae5c-b373-4e6a-8e4b-8b934d578c4f
Armstrong, Thomas A.
8e364434-f4be-48e1-82bf-7957f888a040
Takhar, Arjun S.
dbf44f14-c50a-4613-9843-49f0dd0b236b
Pearce, Neil W.
bbd2fe84-c835-4c73-aa40-ba5fceefa690
Primrose, John N.
d85f3b28-24c6-475f-955b-ec457a3f9185
Harris, Scott
19ea097b-df15-4f0f-be19-8ac42c190028
Verkooijen, Helena M.
65d5e887-441a-4c58-9d5d-5b91918b444a
van Gulik, Thomas M.
9ddabede-cd8e-42b9-aa44-ff3a9bf96010
Hagendoorn, Jeroen
a6eff1d2-4f0a-439f-9a96-5931e3b03e0f
Busch, Olivier R.
4ace2e73-95fc-4c7d-9972-ee5137cc1107
Johnson, Colin D.
e50aa9cd-8c61-4fe3-a0b3-f51cc3a6c74a
Besselink, Marc G.
5161301c-7dd8-4806-ad35-b721762506ae

Samim, Morsal, Mungroop, Timothy H., Abuhilal, Mohammed Abuhilal, Isfordink, Cas J., Molenaar, Quintus I., van der Poel, Marcel J., Armstrong, Thomas A., Takhar, Arjun S., Pearce, Neil W., Primrose, John N., Harris, Scott, Verkooijen, Helena M., van Gulik, Thomas M., Hagendoorn, Jeroen, Busch, Olivier R., Johnson, Colin D. and Besselink, Marc G. , HPB-RISC Study Group (2018) Surgeons' assessment versus risk models for predicting complications of hepato-pancreato-biliary surgery (HPB-RISC): a multicenter prospective cohort study. HPB, 20 (9), 809-814. (doi:10.1016/j.hpb.2018.02.635).

Record type: Article

Abstract

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.

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RISC manuscript v4-12-16 - Accepted Manuscript
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More information

Accepted/In Press date: 24 February 2018
e-pub ahead of print date: 17 April 2018
Published date: 1 September 2018
Additional Information: Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
Keywords: Journal Article

Identifiers

Local EPrints ID: 422573
URI: https://eprints.soton.ac.uk/id/eprint/422573
ISSN: 1365-182X
PURE UUID: c1c74f34-3a34-405c-8b00-19781538965f
ORCID for John N. Primrose: ORCID iD orcid.org/0000-0002-2069-7605

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Date deposited: 25 Jul 2018 16:30
Last modified: 18 Apr 2019 04:01

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Contributors

Author: Morsal Samim
Author: Timothy H. Mungroop
Author: Mohammed Abuhilal Abuhilal
Author: Cas J. Isfordink
Author: Quintus I. Molenaar
Author: Marcel J. van der Poel
Author: Thomas A. Armstrong
Author: Arjun S. Takhar
Author: Neil W. Pearce
Author: Scott Harris
Author: Helena M. Verkooijen
Author: Thomas M. van Gulik
Author: Jeroen Hagendoorn
Author: Olivier R. Busch
Author: Marc G. Besselink

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