Training prediction models for individual risk assessment of postoperative complications after surgery for colorectal cancer.

BACKGROUND: The occurrence of postoperative complications and anastomotic leakage are major drivers of mortality in the immediate phase after colorectal cancer surgery. We trained prediction models for calculating patients' individual risk of complications based only on preoperatively available data in a multidisciplinary team setting. Knowing prior to surgery the probability of developing a complication could aid in improving informed decision-making by surgeon and patient and individualize surgical treatment trajectories. METHODS: All patients over 18 years of age undergoing any resection for colorectal cancer between January 1, 2014 and December 31, 2019 from the nationwide Danish Colorectal Cancer Group database were included. Data from the database were converted into Observational Medical Outcomes Partnership Common Data Model maintained by the Observation Health Data Science and Informatics initiative. Multiple machine learning models were trained to predict postoperative complications of Clavien-Dindo grade ≥ 3B and anastomotic leakage within 30 days after surgery. RESULTS: Between 2014 and 2019, 23,907 patients underwent resection for colorectal cancer in Denmark. A Clavien-Dindo complication grade ≥ 3B occurred in 2,958 patients (12.4%). Of 17,190 patients that received an anastomosis, 929 experienced anastomotic leakage (5.4%). Among the compared machine learning models, Lasso Logistic Regression performed best. The predictive model for complications had an area under the receiver operating characteristic curve (AUROC) of 0.704 (95%CI 0.683-0.724) and an AUROC of 0.690 (95%CI 0.655-0.724) for anastomotic leakage. CONCLUSIONS: The prediction of postoperative complications based only on preoperative variables using a national quality assurance colorectal cancer database shows promise for calculating patient's individual risk. Future work will focus on assessing the value of adding laboratory parameters and drug exposure as candidate predictors. Furthermore, we plan to assess the external validity of our proposed model.

Managerial attitudes on the development of health promoting hospitals in Beijing.

In 2002, the Beijing Committee for Disease Prevention launched guidelines based on the Ottawa Charter for Health Promotion on health promoting hospitals (HPHs). HPH pilot projects were then initiated, on a voluntary basis, in 44 Beijing hospitals. Evaluations have been undertaken to assess the impacts of the pilot project. This article outlines this HPH project, its development and evaluation and reports on the attitudes and contribution of hospital management as determined by questionnaires and interviews from 281 managerial employees from 106 Beijing hospitals (93 from pilot hospitals and 188 from control). The results of the evaluation indicate that long-term health promotion planning and health promotion specialized funds have been better established in pilot hospitals than in the control group and also that the concept of HPH is better understood by managerial staff in pilot hospitals than by those in control hospitals. The main perceived barriers faced in the development of HPH are shortages of funds, personnel, time management and professional skills. To further develop HPHs in China, effort needs to be made to ensure that hospital leaders and management are considered first. If managerial staff have an appropriate understanding of the concept and principles of HPH, then it is more likely that health promotion activities can be introduced into the daily workings of hospitals, and the necessary funds, personnel and training on health promotion skills be provided.

Health policy reform in the People's Republic of China.

With very limited resources, China has developed perhaps the world's largest network of health care services. The health status of its peoples has risen dramatically during the past 40 years. The reasons for these achievements are complex and include an ideology of equity for all citizens, the near universal availability of adequate food, education, housing, jobs, and transport, and the universal availability of accessible and affordable treatment and preventive health services. Despite these achievements China is facing new problems. These include the aging of the population, continued growth of the population leading to ever increasing demands on all sectors of the economy including health services, urban-rural inequalities, low productivity in the health services, lack of legal safeguards for health protection, a continued burden of infectious and endemic diseases, weak infrastructure for prevention and primary health care, and an increasing burden of chronic diseases associated with tobacco smoking and atherosclerotic circulatory diseases and trauma due to traffic accidents and occupational hazards. Decentralized management, financial incentives for health workers, privatization of medical practitioners, health legislation, and changes to health insurance arrangements have been introduced as a means of addressing the issues. The outcomes have been uneven, with little or no improvements in some problems and good progress in others. Changes in the health system appear to be reflecting not only health reform measures but also general economic reforms.