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Published: Sat, April 22, 2017
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The Association of Coloproctology of Great Britain and Irela ...: Annals of Surgery

The Association of Coloproctology of Great Britain and Irela ...: Annals of Surgery

Background: This study was designed to investigate the early outcomes of surgical treatment of malignant large bowel obstruction (MBO) and to identify risk factors affecting operative mortality. Were prospectively collected from 1046 patients with MBO by 294 surgeons in 148 UK hospitals during a 12-month period from April 1998. A predictive model of in-hospital mortality was developed using a 3-level Bayesian logistic regression analysis.

P> Results: The median age of patients was 73 years (interquartile range 64-80). Of the 989 patients having surgery, 91.7% underwent bowel resection with an overall mortality of 15.7%. The multilevel model used the following independent risk factors to predict mortality: OR (1.85 per 10 year increase), American Society of Anesthesiologists grade (OR for American Society of Anesthesiologists grade I versus II, III, IV-V = Dukes 'staging (OR for Dukes' A versus B, C, D = 2.0, 2.1, 6.0), and mode of surgery (OR for scheduled versus urgent, emergency = 1.6, 2.3). A significant inter-hospital variability in operative mortality was evident with increasing age (variance = 0.004, SE = 0.001, P <0.001). Conclusion: Using prognostic models, it was possible to develop a risk-stratification index that accurately predicted survival in patients presenting with malignant large bowel obstruction. The methodology and model for risk adjusted survival can set the reference point for more accurate and reliable comparative analysis and be used as an adjunct to the process of informed consent.

From the * Department of Surgery, St Mark's Hospital, Harrow, UK; † Dendrite Clinical Systems Ltd, Henley-on-Thames, UK; Department of Surgery, Queen Alexandra Hospital, Portsmouth, UK;

Predictably - definition of predictably
The resolution of the tragedy would indicate, predictably, Calderon's position in favor of the counter-reformist creed. January 2, which is expected to force Castelar to resign.

Supported by the "Hue Falwasser" research fellowship of The Royal College of Surgeons of England.

Orally presented at The research forum at The American Society of Colon and Rectal Surgeons Annual Convention, Chicago, June 3-8, 2002.

Reprints: Mr Jeffrey D. Stamatakis, MS, FRCS (Eng), FRCS (Ed) , Department of Surgery, Princess of Wales Hospital, Coity Road, Bridgend, CF31 1RQ, UK. E-mail: jeff.stamatakis@bromor-tr.wales.nhs.uk.

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