On the predictability of postoperative complications for cancer patients: a Portuguese cohort study

Funding Information: This work was supported by the FCT, through IDMEC, under LAETA project (UIDB/50022/2020), IPOscore project with reference DSAIPA/DS/0042/2018, and Data2Help (DSAIPA/DS/0044/2018). This work was further supported by the Associate Laboratory for Green Chemistry – LAQV which is financed by national funds from FCT/MCTES (UIDB/50006/2020, UIDP/50006/2020), INESC-ID pluriannual (UIDB/50021/2020), and the contract CEECIND/01399/2017. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.Postoperative complications are still hard to predict despite the efforts towards the creation of clinical risk scores. The published scores contribute for the creation of specialized tools, but with limited predictive performance and reusability for implementation in the oncological context. This work aims to predict postoperative complications risk for cancer patients, offering two major contributions. First, to develop and evaluate a machine learning-based risk score, specific for the Portuguese population using a retrospective cohort of 847 cancer patients undergoing surgery between 2016 and 2018, for 4 outcomes of interest: (1) existence of postoperative complications, (2) severity level of complications, (3) number of days in the Intermediate Care Unit (ICU), and (4) postoperative mortality within 1 year. An additional cohort of 137 cancer patients from the same center was used for validation. Second, to improve the interpretability of the predictive models. In order to achieve these objectives, we propose an approach for the learning of risk predictors, offering new perspectives and insights into the clinical decision process. For postoperative complications the Receiver Operating Characteristic Curve (AUC) was 0.69, for complications’ severity AUC was 0.65, for the days in the ICU the mean absolute error was 1.07 days, and for 1-year postoperative mortality the AUC was 0.74, calculated on the development cohort. In this study, predictive models which could help to guide physicians at organizational and clinical decision making were developed. Additionally, a web-based decision support tool is further provided to this end.publishersversionpublishe

A AVALIAÇÃO DO RISCO CIRÚRGICO É CRUCIAL PARA MITIGAR AS COMPLICAÇÕES PÓS-OPERATÓRIAS

Postoperative complications often determine the failure of a meticulous and adequate surgical intervention. The surgical risk assessment allows the identification of patients who can benefit from a program to optimize their general condition, reducing the risk of postoperative complications. The purpose of this article is to address the main factors associated with increased perioperative risk as well as the most appropriate tools for an objective assessment of surgical risk and to use this information to mitigate postoperative complications.As complicações pós-operatórias determinam, muitas vezes, o insucesso de uma meticulosa e adequada intervenção cirúrgica. A avaliação do risco cirúrgico permite identificar os doentes que podem beneficiar de um programa de otimização do seu estado geral, reduzindo o risco de complicações pós-operatórias. O propósito deste artigo é abordar os principais fatores associados ao aumento do risco perioperatório assim como as ferramentas mais adequadas para uma avaliação objetiva do risco cirúrgico e usar essa informação na mitigação das complicações pós-operatórias

IMPLEMENTAÇÃO DO TEXTBOOK ONCOLOGIC OUTCOME NO DEPARTAMENTO DE ONCOLOGIA CIRÚRGICA DO IPO-PORTO: RESULTADOS PRELIMINARES

Background: Textbook Oncologic Outcome (TOO) serves as a comprehensive quality metric, representing the optimal outcome for oncological patients undergoing therapeutic surgery and, consequently, indicating the quality of healthcare provided. Methods: The TOO variables were applied to the entire cohort of adult patients (≥18 years of age) diagnosed with esophagus, stomach, pancreas, colon, rectum, urinary bladder, or ovarian cancer at the Portuguese Institute of Oncology of Porto (IPO-Porto) between January 1st, 2022, and June 30th, 2022. This evaluation specifically included patients who underwent surgery with curative intent. Results: A thorough assessment was conducted on 288 patients. Among the 143 patients with colon cancer, 69.9% achieved the TOO benchmark; for the 46 rectum cancer patients, TOO was attained by 57.1%; 40.0% of the 15 patients with esophageal cancer met the TOO criteria; 59.7% of the 67 patients with stomach cancer achieved TOO; 40% of the 5 patients with pancreatic cancer met the TOO standard; 45.5% of the 12 patients with urinary bladder cancer achieved TOO, while 66.7% of the 9 women with ovarian cancer reached the TOO benchmark. These results are comparable to those of the best comprehensive cancer centers. Conclusions: Achieving optimal TOO not only signifies the quality of patient care but also reflects positively on the institution. Subsequently, despite obtaining relevant results, there is potential for improving outcomes for patients at IPO-Porto, particularly concerning the evaluated cancers.Introdução: O Textbook Oncologic Outcome (TOO) é uma métrica de qualidade composta que representa o desfecho ideal para doentes oncológicos submetidos a cirurgia com intuito curativo, assumindo-se que representa a qualidade dos serviços de saúde prestados.   Métodos: As variáveis do TOO foram aplicadas a todos os doentes adultos do Instituto Português de Oncologia do Porto (IPO-Porto) (≥18 anos de idade) com diagnóstico de cancro do esófago, estômago, pâncreas, cólon, reto, bexiga e ovário, entre 1 de janeiro e 30 de junho de 2022, submetidos a cirurgia com intuito curativo.   Resultados: Foram avaliados no total 288 pacientes. Dos 143 pacientes com cancro do colon, 69,9% atingiram o TOO; 57,1% dos 46 pacientes com cancro do reto atingiram o TOO; 40,0% dos 15 pacientes com cancro do esófago atingiram o TOO; 59,7% dos 67 pacientes com cancro do estômago atingiram o TOO; 40% dos 5 pacientes com cancro do pâncreas atingiram TOO; 45,4% dos 12 pacientes com cancro da bexiga atingiram o TOO; 66,7% das 9 mulheres com cancro do ovário atingiram o TOO. Estes resultados são comparáveis aos obtidos pelos melhores centros oncológicos.   Conclusões: Um TOO ótimo atesta a qualidade dos cuidados prestados ao doente, bem como da instituição. Apesar dos resultados obtidos serem relevantes, existe possibilidade, no IPO-Porto, para os melhorar particularmente no que diz respeito aos cancros avaliados