Validity of the CR-POSSUM model in surgery for colorectal cancer in Spain (CCR-CARESS study) and comparison with other models to predict operative mortality

Marisa Baré, Manuel Jesús Alcantara, Maria José Gil, Pablo Collera, Marina Pont, Antonio Escobar, Cristina Sarasqueta, Maximino Redondo, Eduardo Briones, Paula Dujovne, Jose Maria Quintana, Francisco Rivas, Elena Campano, Ana Isabel Sotelo, Francisco Medina, Arturo Del Rey, Maria M. Morales, Segundo Gómez, Núria Torà, Miquel PeraJosep Alfons Espinàs, Mireia Espallargues, Caridad Almazán, Mercè Comas, Nerea Fernández, Juan Antonio Blasco, Isabel Del Cura, José María Fernández, Rocío Anula, Julio Ángel Mayol, Ramón Cantero, Héctor Guadalajara, María Heras, Damián García, Mariel Morey, Nerea González, Susana García, Iratxe Lafuente, Urko Aguirre, Miren Orive, Josune Martin, Ane Antón, Santiago Lázaro, Jose María Enriquez, Carlos Placer, Amaia Perales, Amaia Bilbao, Alberto Loizate, Inmaculada Arostegui, José Errasti, Iñaki Urkidi, Jose María Erro, Enrique Cormenzana, Antonio Z. Gimeno

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5 Citations (Scopus)


© 2018 The Author(s). Background: To validate and recalibrate the CR- POSSUM model and compared its discriminatory capacity with other European models such as POSSUM, P-POSSUM, AFC or IRCS to predict operative mortality in surgery for colorectal cancer. Methods: Prospective multicenter cohort study from 22 hospitals in Spain. We included patients undergoing planned or urgent surgery for primary invasive colorectal cancers between June 2010 and December 2012 (N = 2749). Clinical data were gathered through medical chart review. We validated and recalibrated the predictive models using logistic regression techniques. To calculate the discriminatory power of each model, we estimated the areas under the curve - AUC (95% CI). We also assessed the calibration of the models by applying the Hosmer-Lemeshow test. Results: In-hospital mortality was 1.5% and 30-day mortality, 1.7%. In the validation process, the discriminatory power of the CR-POSSUM for predicting in-hospital mortality was 73.6%. However, in the recalibration process, the AUCs improved slightly: the CR-POSSUM reached 75.5% (95% CI: 67.3-83.7). The discriminatory power of the CR-POSSUM for predicting 30-day mortality was 74.2% (95% CI: 67.1-81.2) after recalibration; among the other models the POSSUM had the greatest discriminatory power, with an AUC of 77.0% (95% CI: 68.9-85.2). The Hosmer-Lemeshow test showed good fit for all the recalibrated models. Conclusion: The CR-POSSUM and the other models showed moderate capacity to discriminate the risk of operative mortality in our context, where the actual operative mortality is low. Nevertheless the IRCS might better predict in-hospital mortality, with fewer variables, while the CR-POSSUM could be slightly better for predicting 30-day mortality.
Original languageEnglish
Article number49
JournalBMC Health Services Research
Publication statusPublished - 29 Jan 2018


  • Colorectal cancer
  • Cr-possum
  • Operative mortality
  • Predictive model


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