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

S. Sahami, S. A L Bartels, A. D'Hoore, T. Young Fadok, P. J. Tanis, A. de Buck van Overstraeten, A. M. Wolthuis, C. J. Buskens, W. A. Bemelman

Research output: Contribution to journalArticle

2 Citations (Scopus)

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. 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. 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). 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.

Original languageEnglish (US)
Pages (from-to)181-187
Number of pages7
JournalColorectal Disease
Volume19
Issue number2
DOIs
StatePublished - Feb 1 2017

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Restorative Proctocolectomy
Crohn Disease
Anastomotic Leak
Survival
Tertiary Healthcare
Survival Analysis
Diabetes Mellitus
Regression Analysis
Maintenance
Outcome Assessment (Health Care)

Keywords

  • external validation
  • handsewn anastomosis
  • Pouch failure
  • prognostic model
  • restorative proctocolectomy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Sahami, S., Bartels, S. A. L., D'Hoore, A., Young Fadok, T., Tanis, P. J., de Buck van Overstraeten, A., ... Bemelman, W. A. (2017). External validation of a prognostic model of preoperative risk factors for failure of restorative proctocolectomy. Colorectal Disease, 19(2), 181-187. https://doi.org/10.1111/codi.13414

External validation of a prognostic model of preoperative risk factors for failure of restorative proctocolectomy. / Sahami, S.; Bartels, S. A L; D'Hoore, A.; Young Fadok, T.; Tanis, P. J.; de Buck van Overstraeten, A.; Wolthuis, A. M.; Buskens, C. J.; Bemelman, W. A.

In: Colorectal Disease, Vol. 19, No. 2, 01.02.2017, p. 181-187.

Research output: Contribution to journalArticle

Sahami, S, Bartels, SAL, D'Hoore, A, Young Fadok, T, Tanis, PJ, de Buck van Overstraeten, A, Wolthuis, AM, Buskens, CJ & Bemelman, WA 2017, 'External validation of a prognostic model of preoperative risk factors for failure of restorative proctocolectomy', Colorectal Disease, vol. 19, no. 2, pp. 181-187. https://doi.org/10.1111/codi.13414
Sahami S, Bartels SAL, D'Hoore A, Young Fadok T, Tanis PJ, de Buck van Overstraeten A et al. External validation of a prognostic model of preoperative risk factors for failure of restorative proctocolectomy. Colorectal Disease. 2017 Feb 1;19(2):181-187. https://doi.org/10.1111/codi.13414
Sahami, S. ; Bartels, S. A L ; D'Hoore, A. ; Young Fadok, T. ; Tanis, P. J. ; de Buck van Overstraeten, A. ; Wolthuis, A. M. ; Buskens, C. J. ; Bemelman, W. A. / External validation of a prognostic model of preoperative risk factors for failure of restorative proctocolectomy. In: Colorectal Disease. 2017 ; Vol. 19, No. 2. pp. 181-187.
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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. 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. 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). 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.",
keywords = "external validation, handsewn anastomosis, Pouch failure, prognostic model, restorative proctocolectomy",
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AU - Bartels, S. A L

AU - D'Hoore, A.

AU - Young Fadok, T.

AU - Tanis, P. J.

AU - de Buck van Overstraeten, A.

AU - Wolthuis, A. M.

AU - Buskens, C. J.

AU - Bemelman, W. A.

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N2 - 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. 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. 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). 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.

AB - 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. 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. 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). 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.

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KW - Pouch failure

KW - prognostic model

KW - restorative proctocolectomy

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