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The development and validation of the Calculation of post-Operative Risk in Emergency Surgery (CORES) model

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Abstract

Purpose

This study was undertaken to establish a model to predict the post-operative mortality for emergency surgeries.

Methods

A regression model was constructed to predict in-hospital mortality using data from a cohort of 479 cases of emergency surgery performed in a Japanese referral hospital. The discrimination power of the current model termed the Calculation of post-Operative Risk in Emergency Surgery (CORES), and Portsmouth modification of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) were validated using the area under the receiver operating characteristic curve (AUC) in another cohort of 494 cases in the same hospital (validation subset). We further evaluated the accuracy of the CORES in a cohort of 1,471 cases in six hospitals (multicenter subset).

Results

CORES requires only five preoperative variables, while the P-POSSUM requires 20 variables. In the validation subset, the CORES model had a similar discrimination power as the P-POSSUM for detecting in-hospital mortality (AUC, 95 % CI for CORES: 0.86, 0.80–0.93; for P-POSSUM: 0.88, 0.82–0.93). The predicted mortality rates of the CORES model significantly correlated with the severity of the post-operative complications. The subsequent multicenter study also demonstrated that the CORES model exhibited a high AUC value (0.85: 0.81–0.89) and a significant correlation with the post-operative morbidity.

Conclusions

This model for emergency surgery, the CORES, demonstrated a similar discriminatory power to the P-POSSUM in predicting post-operative mortality. However, the CORES model has a substantial advantage over the P-POSSUM in that it utilizes far fewer variables.

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Acknowledgements

The authors have no financial support or conflict of interests with regard to this study. The authors wish to thank Professor Jonathan D. Kaunitz, M.D., UCLA School of Medicine, for his helpful comments. The authors also appreciate all of the institutional investigators listed below for collecting the patients’ data or coordinating the data collection: (1) Yoshikazu Haratake, M.D., Yoichiro Sakata, M.D., Kiyohiko Kato, M.D., Hiroko Iwamasa, M.D., Yuji Kunitoku, M.D., Kotaro Murakami, M.D., Ayako Haga, M.D., Yukiko Tokunaga, M.D., Taichi Kotani, M.D., Junya Matsumura, M.D. from Saiseikai Kumamoto Hospital. (2) Noriko Narimatsu, M.D., Takahiro Nonaka, M.D., Masahiro Hashimoto, M.D., Masahiro Onoda, M.D., Chiaki Ito, M.D., Tomoko Uehara, M.D. from Kumamoto Rosai Hospital. (3) Michiaki Sadanaga, M.D. from Japanese Red Cross Kumamoto Hospital. (4) Akihiko Tajiri, M.D. from Minamata City Hospital and Medical Center.

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Authors and Affiliations

  1. Department of Anesthesiology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan

    Naoki Miyazaki

  2. Department of International Medical Cooperation, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Naoki Miyazaki & Yoshio Haga

  3. Institute for Clinical Research, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan

    Yoshio Haga

  4. Department of Anesthesiology, Japanese Red Cross Kumamoto Hospital, 2-1-1 Higashi-ku, Nagamineminami, Kumamoto, 861-8520, Japan

    Hidekazu Matsukawa & Tatsuhiro Ishimura

  5. Department of Anesthesiology, Saiseikai Kumamoto Hospital, 5-3-1 Chikami-machi, Minami-ku, Kumamoto, 861-4193, Japan

    Miki Fujita

  6. Department of Anesthesiology, Japan Labor Health and Welfare Organization, Kumamoto Rosai Hospital, 1670 Takehara-Cho, Yatsushiro, Kumamoto, 866-8533, Japan

    Tadashi Ejima

  7. Department of Anesthesiology, Kumamoto Social Insurance General Hospital, 2-26 Matsuejo, Yatsushiro, Kumamoto, 866-8660, Japan

    Hironari Tanimoto

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  1. Naoki Miyazaki
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  2. Yoshio Haga
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  3. Hidekazu Matsukawa
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  4. Tatsuhiro Ishimura
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Correspondence to Yoshio Haga.

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Miyazaki, N., Haga, Y., Matsukawa, H. et al. The development and validation of the Calculation of post-Operative Risk in Emergency Surgery (CORES) model. Surg Today 44, 1443–1456 (2014). https://doi.org/10.1007/s00595-013-0707-1

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  • DOI: https://doi.org/10.1007/s00595-013-0707-1

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