{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T07:52:42Z","timestamp":1761724362815,"version":"build-2065373602"},"reference-count":34,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000724","name":"Health Foundation","doi-asserted-by":"publisher","award":["AIMS ID: 430167"],"award-info":[{"award-number":["AIMS ID: 430167"]}],"id":[{"id":"10.13039\/501100000724","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001297","name":"Royal College of Anaesthetists","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001297","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Over 1.5\u2009million major surgical procedures take place in the UK NHS each year and approximately 25% of patients develop at least one complication. The most widely used risk\u2010adjustment model for postoperative morbidity in the UK is the physiological and operative severity score for the enumeration of mortality and morbidity. However, this model was derived more than 30\u2009years ago and now overestimates the risk of morbidity. In addition, contemporary definitions of some model predictors are markedly different compared with when the tool was developed. A second model used in clinical practice is the American College of Surgeons National Surgical Quality Improvement Programme risk model; this provides a risk estimate for a range of postoperative complications. This model, widely used in North America, is not open source and therefore cannot be applied to patient populations in other settings. Data from a prospective multicentre clinical dataset of 118 NHS hospitals (the peri\u2010operative quality improvement programme) were used to develop a bespoke risk\u2010adjustment model for postoperative morbidity. Patients aged \u2265\u200918\u2009years who underwent colorectal surgery were eligible for inclusion. Postoperative morbidity was defined using the postoperative morbidity survey at postoperative day\u20097. Thirty\u2010one candidate variables were considered for inclusion in the model. Death or morbidity occurred by postoperative day\u20097 in 3098 out of 11,646 patients (26.6%). Twelve variables were incorporated into the final model, including (among others): Rockwood clinical frailty scale; body mass index; and index of multiple deprivation quintile. The C\u2010statistic was 0.672 (95%CI 0.660\u20130.684), with a bootstrap optimism corrected C\u2010statistic of 0.666 at internal validation. The model demonstrated good calibration across the range of morbidity estimates with a mean slope gradient of predicted risk of 0.959 (95%CI 0.894\u20131.024) with an index\u2010corrected intercept of \u22120.038 (95%CI \u22120.112\u20130.036) at internal validation. Our model provides parsimonious case\u2010mix adjustment to quantify risk of morbidity on postoperative day\u20097 for a UK population of patients undergoing major colorectal surgery. Despite the C\u2010statistic of &lt;\u20090.7, our model outperformed existing risk\u2010models in widespread use. We therefore recommend application in case\u2010mix adjustment, where incorporation into a continuous monitoring tool such as the variable life adjusted display or exponentially\u2010weighted moving average\u2010chart could support high\u2010level monitoring and quality improvement of risk\u2010adjusted outcome at the population level.<\/jats:p>","DOI":"10.1111\/anae.15858","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T21:03:04Z","timestamp":1663794184000},"page":"1356-1367","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Development and internal validation of a model for postoperative morbidity in adults undergoing major elective colorectal surgery: the peri\u2010operative quality improvement programme (\n                    <scp>PQIP<\/scp>\n                    ) colorectal risk model"],"prefix":"10.1111","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6045-3226","authenticated-orcid":false,"given":"J.","family":"Bedford","sequence":"first","affiliation":[{"name":"UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Peri\u2010operative Medicine University College London Hospitals NHS Foundation Trust  London UK"},{"name":"Centre for Peri\u2010operative Medicine, Research Department for Targeted Intervention UCL Division of Surgery and Interventional Science  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Applied Health Research University College London  UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Crowe","sequence":"additional","affiliation":[{"name":"Clinical Operational Research Unit University College London  UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Wagstaff","sequence":"additional","affiliation":[{"name":"UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Peri\u2010operative Medicine University College London Hospitals NHS Foundation Trust  London UK"},{"name":"Centre for Peri\u2010operative Medicine, Research Department for Targeted Intervention UCL Division of Surgery and Interventional Science  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Santos","sequence":"additional","affiliation":[{"name":"Health Services Research Centre, National Institute for Academic Anaesthesia Royal College of Anaesthetists  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.","family":"Singleton","sequence":"additional","affiliation":[{"name":"Centre for Peri\u2010operative Medicine Research Department for Targeted Intervention UCL Division of Surgery and Interventional Science  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Baumber","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Royal National Orthopaedic Hospital NHS Trust  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Vindrola\u2010Padros","sequence":"additional","affiliation":[{"name":"Research Department for Targeted Intervention UCL Division of Surgery and Interventional Science  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Vohra","sequence":"additional","affiliation":[{"name":"Department of Surgery Nottingham University Hospitals NHS Trust  Nottingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Swart","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Torbay and South Devon NHS Trust  Devon UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. M.","family":"Oliver","sequence":"additional","affiliation":[{"name":"UCLH Surgical Outcomes Research Centre, Department of Anaesthesia and Peri\u2010operative Medicine University College London Hospitals NHS Foundation Trust  London UK"},{"name":"Centre for Peri\u2010operative Medicine Research Department for Targeted Intervention UCL Division of Surgery and Interventional Science  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Dorey","sequence":"additional","affiliation":[{"name":"Lay Committee Royal College of Anaesthetists and Lay representatives PQIP Project team  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I.","family":"Leeman","sequence":"additional","affiliation":[{"name":"Lay Committee Royal College of Anaesthetists and Lay representatives PQIP Project team  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6730-5824","authenticated-orcid":false,"given":"S. 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