MP2-04 EVALUATION OF THE ACS NSQIP SURGICAL RISK CALCULATOR IN PATIENTS UNDERGOING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 2014MP2-04 EVALUATION OF THE ACS NSQIP SURGICAL RISK CALCULATOR IN PATIENTS UNDERGOING RADICAL CYSTECTOMY Jeffrey Tomaszewski, Elizabeth Handorf, Alexander Kutikov, Reza Mehrazin, Bic Cung, Simon Kim, Rosalia Viterbo, David Chen, Richard Greenberg, Henry Pitt, Nestor Esnaola, Robert Uzzo, and Marc Smaldone Jeffrey TomaszewskiJeffrey Tomaszewski More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Bic CungBic Cung More articles by this author , Simon KimSimon Kim More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , David ChenDavid Chen More articles by this author , Richard GreenbergRichard Greenberg More articles by this author , Henry PittHenry Pitt More articles by this author , Nestor EsnaolaNestor Esnaola More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Marc SmaldoneMarc Smaldone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.162AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The National Surgical Quality Improvement Project (NSQIP) Surgical Risk Calculator is a tool created by the American College of Surgeons (ACS) to estimate risk adjusted peri-operative outcomes for commonly performed surgical procedures as a means to measure and improve quality of surgical care. Our objective was to evaluate the accuracy of the Surgical Risk Calculator in patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder. METHODS A prospectively maintained, institutional, database was queried for all patients undergoing RC from 2007-2011. For each patient, 22 designated preoperative risk factors were entered into the NSQIP calculator to obtain estimates of 30 day peri-operative mortality, post-operative complications, and hospital length of stay (HLOS). To assess overall calibration of risks predicted by the Surgical Risk Calculator, we calculated the difference between mean predicted risk and the observed rate of surgical outcomes in our cohort. To assess statistical significance of differences between observed and expected outcomes, we used a bootstrap with 1,000 replicates, calculated confidence intervals via the percentile method, and determined p-values using two-sided pivot tests. RESULTS 314 patients undergoing RC were included for analysis. All patients had complete data available for pre-and post-operative risk assessment. Comparing observed to expected events, the NSQIP calculator significantly underestimated the risks of death (-3.3% [CI -1.3--5.4]; p=0.002), serious complications (-19.4% [CI -14.1- -24.5]; p<0.001), overall complications (-23.4% [CI -17.6--28.5]; p<0.001), surgical site infections (-5.8% [CI -1.8--9.6]; p=0.002), urinary tract infections (-15.2% [CI -10.8--19.7]; p<0.001), acute renal failure (-3.2% [CI -0.9--6.1]; p=0.008), and hospital length of stay (-4.8 days [CI -3.8--6.0]; p<0.001). There were no significant differences between predicted and observed rates of pneumonia, cardiac morbidity, venous thromboembolism, or need for return to the operating room. CONCLUSIONS Patients undergoing RC had significant differences in several observed versus expected peri-operative outcomes estimated with the ACS NSQIP Surgical Risk Calculator. Growing participation by hospitals in the ACS NSQIP’s Procedure Targeted Option, and creation/incorporation of procedure (e.g. RC)-specific preoperative risk factors and outcomes will likely enhance the accuracy of surgical outcomes estimation by the Surgical Risk Calculator. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e25-e26 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Jeffrey Tomaszewski More articles by this author Elizabeth Handorf More articles by this author Alexander Kutikov More articles by this author Reza Mehrazin More articles by this author Bic Cung More articles by this author Simon Kim More articles by this author Rosalia Viterbo More articles by this author David Chen More articles by this author Richard Greenberg More articles by this author Henry Pitt More articles by this author Nestor Esnaola More articles by this author Robert Uzzo More articles by this author Marc Smaldone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...