Abstract
Objectives: The aim of this retrospective study was to assess the predictive performance of the American College of Surgeons (ACS) risk calculator for aortic aneurysm repair for the patient population of a Dutch tertiary referral hospital. Methods: This retrospective study included all patients who underwent elective endovascular or open aortic aneurysm repair at our institution between the years 2013 and 2019. Preoperative patient demographics and postoperative complication data were collected, and individual risk assessments were generated using five different current procedural terminology (CPT) codes. Receiver operating characteristic (ROC) curves, calibration plots, Brier scores, and Index of Prediction Accuracy (IPA) values were generated to evaluate the predictive performance of the ACS risk calculator in terms of discrimination and calibration. Results: Two hundred thirty-four patients who underwent elective endovascular or open aortic aneurysm repair were identified. Only five out of thirteen risk predictions were found to be sufficiently discriminative. Furthermore, the ACS risk calculator showed a structurally insufficient calibration. Most Brier scores were close to 0; however, comparison to a null model though IPA-scores showed the predictions generated by the ACS risk calculator to be inaccurate. Overall, the ACS risk calculator showed a consistent underestimation of the risk of complications. Conclusions: The ACS risk calculator proved to be inaccurate within the framework of endovascular and open aortic aneurysm repair in our medical center. To minimize the effects of patient selection and cultural differences, multicenter collaboration is necessary to assess the performance of the ACS risk calculator in aortic surgery.
Highlights
As stated in the declaration on the promotion of patient’s rights of the World HealthOrganization (WHO) of 1994, patients have the right to be fully informed about the potential risks and benefits of each procedure [1]
Vosler et al [16] propounded the theory that the complexity of procedures included in American College of Surgeons (ACS) validation studies, which are substantially affected by surgical skill, case dependent variables and level of postoperative care, is a possible reason for inaccuracy of the ACS risk calculator
This study took place in a tertiary referral medical center with patients referred for high complex aneurysm repair which could have an effect on the risk of complications
Summary
As stated in the declaration on the promotion of patient’s rights of the World HealthOrganization (WHO) of 1994, patients have the right to be fully informed about the potential risks and benefits of each procedure [1]. Risk assessment is one of the cornerstones of informed consent and shared decision making It is, of paramount importance, in particular in preoperative consultations [2,3,4]. Preoperative risk assessment can contribute to risk reduction by improving preoperative consultation and work-up It can improve postoperative management since it permits better preparation and planning among treatment teams, it is valuable in patient expectation management and can even provide risk-adjusted comparison of surgical outcomes [4,5,6,7,8,9,10,11]. There is an increasing focus on risk stratification tools [9]
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