National Surgical Quality Improvement Program Risk Calculator Research Articles

NSQIP surgical risk calculator: a useful adjunct for the urology multidisciplinary meeting.

Surgical risk calculators are not often routinely used in Urology Multidisciplinary Meetings (MDM), and little is known about their impact on clinical decision-making. The aim of this study is to assess the utility of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator for decision-making in the Urology MDM setting, with particular consideration given to decisions about surgical candidacy. We analysed all adult patients discussed in our Urology MDM with urological conditions whose management plan could potentially include major surgery. During a MDM, a consensus management decision was made prior to the NSQIP score being revealed to blinded team members. Any change in decision after revealing the score was documented, including rationale. Sixty-three out of 64 eligible cancer cases being discussed at MDM warranted NSQIP scores being revealed to the MDM post initial consensus. 95.2% (n = 60) did not have a change in the MDM management plan after reveal of NSQIP score. The NSQIP score led to a change in the MDM management decision in three cases: two renal cancer cases where management changed to biopsy with view to microwave ablation if positive, and one prostate cancer case, where management changed to recommend against radical prostatectomy. The NSQIP risk calculator was a useful tool and adjunct in the MDM setting. It served as a safety net where surgical risk was not initially properly estimated by team members, and reinforced decisions where there was concordance between NSQIP score and clinical judgement.

Accuracy of National Surgical Quality Improvement Program Risk Calculator Among Elderly Patients Undergoing Pancreas Resection

IntroductionA preoperative goals-of-care discussion is essential in maintaining the autonomy of older adults who require surgery. The purpose of this study was to determine the accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator and its association with age for patients who underwent pancreatectomy. MethodsUsing the American College of Surgeons NSQIP database, patients who underwent pancreatectomy between 2012 and 2015 were identified. Age was categorized into three groups: 18-64, 65-79, and 80-89 y. Analysis of variance and Pearson correlation coefficients were employed to assess differences between age categories in predicted and actual mortality and morbidity. Covariate-adjusted logistic regression models were employed to evaluate associations while accounting for potential confounders. ResultsA total of 17,906 patients were included. The correlation between actual and predicted mortality was low (r = 0.14, P < 0.001). This correlation was weakest for the age category 80-89 y (r = 0.04, P = 0.07) and strongest for 65-79 y category (r = 0.14, P > 0.001). The correlation was weakest among patients who underwent pancreatoduodenectomy (r = 0.06, P = 0.08) and in this group mortality was overestimated for older adults in the age group 80-89 (actual mortality: 3.2% versus predicted mortality: 5.6%, P = 0.08). After adjusting for covariates, the interaction term between age and predicted mortality (P = 0.0021) indicated that the relationship between predicted and actual mortality is significantly influenced by patient age. ConclusionsThe NSQIP risk calculator appears to overestimate mortality and morbidity risk for elderly patients undergoing pancreatoduodenectomy. These predictions should be used with caution in preoperative goals-of-care discussions with patients aged 80 y and older.

Risk Reduction and Perioperative Complications in Diabetics with Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction

Category:Diabetes; OtherIntroduction/Purpose:Modern Patient Safety Programs focus on medical optimization prior to surgery, regional anesthesia and hospitalist-orthopaedic co-management during the perioperative period.Methods:Eighty-five consecutive diabetic patients with multiple medical co-morbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized perioperative medical optimization program, which included medical optimization prior to surgery, regional anesthesia whenever possible and hospitalist-orthopaedic comanagement during hospitalization. Charts were retrospectively reviewed for medical comorbidities, complications, and length of stay. The National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk.Results:On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values (RR = 1.36; P =.01) and congestive heart failure (RR = 1.42; P =.02). There were 22 (27%) complications, though only 10 (12%) were serious. These included acute kidney injury (n = 6), sepsis (n = 2), one cardiac event, and one pulmonary embolism. Overall, the accuracy of predicting a complication using the NSQIP risk calculator was 74% (95% CI: 63% - 85%) which was comparable to the accuracy of predicting a complication using only patients' congestive heart failure and pin-tract infection statuses (c = 74%, 95% CI: 62% - 86%).Conclusion:Medical optimization of diabetic patients with multiple medical co-morbidities prior to elective complex reconstruction orthopaedic surgery leads to improved clinical outcomes. Preoperative anemia and congestive heart failure are associated with longer hospitalizations in this patient group. The American College of Surgeons NSQIP Risk Calculator is a reliable predictor of complications in the perioperative period. This study demonstrates that reconstructive surgery in this complex patient population can be accomplished with a reasonable exposure to risk for complication.

Risk Reduction and Perioperative Complications in Patients With Diabetes and Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction.

Modern patient safety programs focus on medical optimization of patients prior to surgery, regional anesthesia when possible, and hospitalist-orthopedic co-management during the perioperative period. Eighty-five consecutive patients with diabetes and multiple medical comorbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized risk reduction program that included medical optimization prior to surgery, regional anesthesia whenever possible, and hospitalist-orthopedic co-management during the perioperative period. Charts were retrospectively reviewed for medical comorbidities, complications, and length of stay. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk. On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values (rate ratio [RR], 1.36; P = .01) and congestive heart failure (RR, 1.42; P = .02). There were 22 (26%) complications, though only 10 (12%) were serious. These included acute kidney injury (n = 6), sepsis (n = 2), 1 cardiac event, and 1 pulmonary embolism. Overall, the accuracy of predicting a complication using the ACS NSQIP Risk Calculator was 74% (95% CI, 63%-85%), which was comparable to the accuracy of predicting a complication using only patients' congestive heart failure and pin-tract infection statuses (c = 74%, 95% CI, 62%-86%). Medical optimization of patients with diabetes and multiple medical comorbidities prior to elective complex reconstruction orthopedic surgery allows the surgery to be performed with a predictable risk for perioperative complications. Preoperative anemia and congestive heart failure are associated with longer hospitalizations in this patient group. The ACS NSQIP Risk Calculator appears to be a reliable predictor of complications during the perioperative period. This study demonstrates that reconstructive surgery in this complex patient population can be accomplished with a reasonable exposure to perioperative risk. Level IV, retrospective case series.

Resident-Championed Quality Improvement Provides Value: Confronting Prolonged Mechanical Ventilation

BackgroundThe Quality In-Training Initiative (QITI) provides hands-on quality improvement education for residents. As our institution has ranked in the bottom quartile for prolonged mechanical ventilation (PMV) according to the National Surgical Quality Improvement Program (NSQIP), we sought to illustrate how our resident-led QITI could be used to determine perioperative contributors to PMV. Materials and methodsThe Model for Improvement framework (developed by Associates in Process Improvement) was used to target postoperative ventilator management. However, baseline findings from our 2016 NSQIP data suggested that preoperative patient factors were more likely contributing to PMV. Subsequently, a retrospective one-to-one case-control study was developed, comparing preoperative NSQIP risk calculator profiles for PMV patients to case-matched patients for age, sex, procedure, and emergent case status. Chart review determined ventilator time, 30-d outcomes, and all-cause mortality. ResultsForty-five patients with PMV (69% elective) had a median ventilator time of 134 h (interquartile range 87-254). The NSQIP calculator demonstrated increased preoperative risk percentages in PMV patients when compared to case-matched patients for any complication (includes PMV), predicted length of stay, and death (all P < 0.05). Thirty-day outcomes were worse for the PMV group in categories for sepsis, pneumonia, unplanned reoperation, 30-d mortality, rehab facility discharge, and length of stay (all P < 0.05). All-cause mortality was also significantly higher for PMV patients (P < 0.05). ConclusionsResident-led QITI projects enhance resident education while exposing opportunities for improving care. Preoperative patient factors play a larger-than-anticipated role in PMV at our institution. Ongoing efforts are aimed toward preoperative identification and optimization of high-risk patients.

Assessment of the American College of Surgeons National Surgical Quality Improvement Program Calculator in Predicting Outcomes and Length of Stay After Ivor Lewis Esophagectomy: A Single-Center Experience

BackgroundThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) calculator is a useful tool used by physicians to better inform patients on the surgical risk of postoperative complications. It makes use of the NSQIP database to derive the chance for several adverse outcomes to occur postoperatively given certain patient's factors. The aim of this study was to assess its applicability in a series of patients undergoing an Ivor Lewis esophagectomy. MethodsData from 100 consecutive patients who underwent an Ivor Lewis esophagectomy between September 2013 and November 2017 at our institution were reviewed. Each patient was assessed using the ACS NSQIP surgical risk calculator. Actual events in this group were compared with their particular NSQIP-assessed risk. Logistic regression models were used to compare surgical risk calculator estimates binary outcomes such as incidence of postoperative complications such as cardiac events, renal events, surgical site infection, and death. Mixed linear model was used for length of stay (LOS) duration versus observed LOS. C-statistic was for predictive accuracy each binary outcome and intraclass correlation was used for LOS. ResultsC-statistic values were higher than the cutoff (0.75) for surgical site infection and death. The ACS NSQIP risk calculator was poorly predictive of other reported outcomes by the calculator such as cardiac or renal complications. Corroboration between observed LOS and predicted LOS was weak (8 d versus 11 d, respectively, intraclass coefficient 0.04). ConclusionsThis study suggests that the risk calculator is useful for identifying risk of death or surgical site infection but poor at discriminating likelihood of other reported outcomes occurring, such as pneumonia, acute renal failure and cardiac complications for patients who underwent an Ivor Lewis esophagectomy. Estimations for procedure-specific complications for esophagectomy may need reevaluated.

Accuracy of the NSQIP risk calculator for predicting complications following adrenalectomy.

Adrenalectomy is performed to treat functional pathology and remove tumors of malignant concern. The National Surgical Quality Improvement Program (NSQIP) risk calculator predicts 30-day complications and length of stay following index surgical procedures. We assess whether this tool accurately predicts complications following adrenalectomy procedures at a tertiary care academic medical center. A retrospective review was performed for all adrenalectomies at a single institution from 2004 to 2016. 197 patients underwent adrenalectomy without concurrent resections. Predicted risk for NSQIP complications was calculated for each patient. The mean predicted and observed risks (%) at 30days across all patients within each category were determined, and these were compared with two-sided one-sample t tests. Of 197 adrenalectomies, 180 were laparoscopic and 17 were open. For laparoscopic adrenalectomy, ten (5.5%) complications were observed including nine (5%) graded Clavien III or greater. All observed complication rates were significantly different than predicted (p values for all < 0.005). Mean observed length of stay was also significantly less than predicted (1.6 versus 2.1days, p < 0.001). In the open adrenalectomy subgroup, there were no observed complications with observed mean length of stay equivalent to predicted (5.8 versus 5.3, p = 0.08) without a higher readmission rate (5.9 versus 6.0%). Statistical differences were noted between the actual complication rates of adrenalectomy versus those predicted by the NSQIP calculator. Certain observed differences may not necessarily have clinical significance. Urology procedure-specific calculators may better refine predictions for sub-specialty procedures with future work requisite to determine performance across all practice settings.

A Simplified Frailty Index to Predict Outcomes After Radical Cystectomy

BackgroundTraditional surgical risk indices are notoriously inaccurate, especially for the elderly, so there has been a trend to evaluate frailty instead. ObjectiveTo describe a simplified five-item frailty index for evaluating radical cystectomy outcomes and compare its predictive ability with other risk assessment tools for a total patient cohort and a subgroup of patients aged ≥65yr. Design, setting, and participantsThe National Surgical Quality Improvement Program (NSQIP) database from 2007 to 2015 was queried for radical cystectomy cases for bladder cancer. A simplified five-item frailty index (sFI) was created based on previously described measures of frailty. Outcome measurement and statistical analysisCorrelation of the sFI with postoperative outcomes was investigated using multivariate logistic regression analyses. The predictive ability of the sFI was compared to the extended 11-item frailty index, NSQIP risk calculator, and the American Society of Anesthesiologists (ASA) score by comparing the area under the receiver operating characteristic curve. Subgroup analysis was performed for those aged ≥65 yr to evaluate the accuracy of the index in the older age group, for which traditional risk indices are notoriously inaccurate. Results and limitationsOf 5516 cases identified, 10.7% experienced a Clavien grade ≥3 complication within 30 d of surgery. Individuals with an sFI of 3+ had a greater likelihood of experiencing a major complication (odds ratio 3.22, 95% confidence interval 2.01–5.17). The sFI outperformed the ASA score in predicting major complications and had a similar predictive ability to the more complex 11-item index and NSQIP risk calculator. There was also a significant correlation between the sFI and discharge destination. These relationships were consistent in the subgroup of patients aged ≥65yr. The study is limited by the database, which only records 30-d outcomes and does not allow evaluation of long-term sequelae. ConclusionsThere is a strong correlation between frailty assessed via the sFI and radical cystectomy outcomes, including in the elderly. This tool can be used in the clinical setting to counsel patients and aid decision-making. Patient summaryThis study demonstrated that a simple five-item frailty index can be used to assess preoperative risk in patients undergoing radical cystectomy.

The predictive value of risk indices for cardiac complications in living donor liver transplantation.

The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) risk tool and Revised Cardiac Risk Index (RCRI) are recommended tools for cardiovascular assessment before non-cardiac surgery to predict early postoperative cardiac morbidity and mortality. Their predictive value for postoperative cardiovascular morbidity and mortality after liver transplantation is unknown. We aimed to evaluate the validity of these two risk tools to predict early (30-day) cardiovascular complications and in-hospital all-cause mortality. Patients who underwent living donor liver transplantation were retrospectively analyzed. Consecutive 278 adult patients were included and their NSQIP and RCRI scores were calculated. Cardiovascular morbidity occurred in 5 (1.8 %) patients. In-hospital all-cause mortality occurred in 18 (6.4 %) patients. None-of the patients died from cardiac complications. Causes of cardiac morbidity were as follows; acute coronary syndrome in 1 patient, intraoperative cardiac arrest with successful resuscitation in 1 patient, heart failure in 3 patients. Neither the NSQIP nor the RCRI score were associated with cardiovascular morbidity. Only RCRI medium-high score, DM and Nonalcoholic steatohepatitis as transplant indications were associated with in-hospital all-cause mortality (p = 0.001). The NSQIP risk calculator and RCRI scores failed to accurately predict the risk of perioperative cardiac complications (Tab. 3, Ref. 30). Text in PDF www.elis.sk.

ACS NSQIP risk calculator reliability in head and neck oncology: The effect of prior chemoradiation on NSQIP risk estimates following laryngectomy

PurposeTo determine whether inclusion of chemoradiation history increases estimated risk for complications following total laryngectomy using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator. Materials and methodsA retrospective review of 96 patients with laryngeal cancer, approximately half of who had received prior chemoradiation, who underwent laryngectomy between January 2010 and December 2014. NSQIP estimates were calculated and compared to actual event occurrence using receiver operating characteristic (ROC) curves, Brier scores, and risk estimates. ResultsPatients who had received prior chemoradiation were at significantly greater risk for complication postoperatively (OR=2.63, 95% CI=1.145–6.043). NSQIP Calculator discriminability and accuracy were generally poor for this sample. While NSQIP estimates significantly predicted risk for any postoperative complication, pneumonia, and discharge to nursing care for primary laryngectomy patients, predictive capability was lost among salvage laryngectomy patients. NSQIP adjustments to both Somewhat Higher and Significantly Higher Risk categories did not improve predictive capability. Of the risk factors considered by NSQIP, preoperative functional status (p=0.041), age at time of surgery (p<0.008), and inclusion of neck dissection (p=0.035) emerged as significant predictors of actual postoperative complications, though again estimates lost significance among salvage laryngectomy patients. ConclusionsThe NSQIP Calculator may be poorly calibrated to estimate postoperative complication risk for patients previously exposed to chemoradiation undergoing salvage laryngectomy. Caution should be used when estimating postoperative risk among patients undergoing salvage procedures, especially those of older age, poorer functional status, and those requiring neck dissection.

Evaluating the American College of Surgeons National Surgical Quality Improvement project risk calculator: results from the U.S. Extrahepatic Biliary Malignancy Consortium

BackgroundThe objective of this study is to evaluate use of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online risk calculator for estimating common outcomes after operations for gallbladder cancer and extrahepatic cholangiocarcinoma. MethodsSubjects from the United States Extrahepatic Biliary Malignancy Consortium (USE-BMC) who underwent operation between January 1, 2000 and December 31, 2014 at 10 academic medical centers were included in this study. Calculator estimates of risk were compared to actual outcomes. ResultsThe majority of patients underwent partial or major hepatectomy, Whipple procedures or extrahepatic bile duct resection. For the entire cohort, c-statistics for surgical site infection (0.635), reoperation (0.680) and readmission (0.565) were less than 0.7. The c-statistic for death was 0.740. For all outcomes the actual proportion of patients experiencing an event was much higher than the median predicted risk of that event. Similarly, the group of patients who experienced an outcome did have higher median predicted risk than those who did not. ConclusionsThe ACS NSQIP risk calculator is easy to use but requires further modifications to more accurately estimate outcomes for some patient populations and operations for which validation studies show suboptimal performance.

Predictive performance of the American College of Surgeons universal risk calculator in neurosurgical patients.

OBJECTIVE The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) universal Surgical Risk Calculator is an online decision-support tool that uses patient characteristics to estimate the risk of adverse postoperative events. Further validation of this risk calculator in the neurosurgical population is needed; therefore, the object of this study was to assess the predictive performance of the ACS NSQIP Surgical Risk Calculator in neurosurgical patients treated at a tertiary care center. METHODS A single-center retrospective review of 1006 neurosurgical patients treated in the period from September 2011 through December 2014 was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted complications were compared with actual occurrences identified through chart review and administrative quality coding data. Statistical models were used to assess the predictive performance of risk scores. Traditionally, an ideal risk prediction model demonstrates good calibration and strong discrimination when comparing predicted and observed events. RESULTS The ACS NSQIP risk calculator demonstrated good calibration between predicted and observed risks of death (p = 0.102), surgical site infection (SSI; p = 0.099), and venous thromboembolism (VTE; p = 0.164) Alternatively, the risk calculator demonstrated a statistically significant lack of calibration between predicted and observed risk of pneumonia (p = 0.044), urinary tract infection (UTI; p < 0.001), return to the operating room (p < 0.001), and discharge to a rehabilitation or nursing facility (p < 0.001). The discriminative performance of the risk calculator was assessed using the c-statistic. Death (c-statistic 0.93), UTI (0.846), and pneumonia (0.862) demonstrated strong discriminative performance. Discharge to a rehabilitation facility or nursing home (c-statistic 0.794) and VTE (0.767) showed adequate discrimination. Return to the operating room (c-statistic 0.452) and SSI (0.556) demonstrated poor discriminative performance. The risk prediction model was both well calibrated and discriminative only for 30-day mortality. CONCLUSIONS This study illustrates the importance of validating universal risk calculators in specialty-specific surgical populations. The ACS NSQIP Surgical Risk Calculator could be used as a decision-support tool for neurosurgical informed consent with respect to predicted mortality but was poorly predictive of other potential adverse events and clinical outcomes.

PD57-09 NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM SURGICAL RISK CALCULATOR POORLY PREDICTS COMPLICATIONS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY WITH URINARY DIVERSION: THE CASE FOR A PROCEDURE-SPECIFIC RISK CALCULATOR

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation III1 Apr 2017PD57-09 NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM SURGICAL RISK CALCULATOR POORLY PREDICTS COMPLICATIONS IN PATIENTS UNDERGOING RADICAL CYSTECTOMY WITH URINARY DIVERSION: THE CASE FOR A PROCEDURE-SPECIFIC RISK CALCULATOR Melanie Adamsky, Shay Golan, Chuanhong Liao, Scott Johnson, Nimrod Barashi, Raj Bhanvadia, Norm Smith, Gary Steinberg, and Arieh Shalhav Melanie AdamskyMelanie Adamsky More articles by this author , Shay GolanShay Golan More articles by this author , Chuanhong LiaoChuanhong Liao More articles by this author , Scott JohnsonScott Johnson More articles by this author , Nimrod BarashiNimrod Barashi More articles by this author , Raj BhanvadiaRaj Bhanvadia More articles by this author , Norm SmithNorm Smith More articles by this author , Gary SteinbergGary Steinberg More articles by this author , and Arieh ShalhavArieh Shalhav More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2611AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The American College of Surgeons′ National Surgical Quality Improvement Program (NSQIP) Risk Calculator is commonly used in the preoperative setting. The risk profile generated is often used during the informed consent process and may in the near future be used as a quality measure linked with reimbursement. We aimed to evaluate the accuracy of this NSQIP risk calculator in patients undergoing radical cystectomy with urinary diversion. METHODS We retrospectively reviewed our institutional database to identify patients undergoing radical cystectomy with urinary diversion between 2010 and 2015. We used the proprietary NSQIP online calculator, which incorporated the procedure-specific CPT code, to obtain a 30-day postoperative risk profile for each of eleven outcomes, which were then compared to actual outcomes for each patient. Brier scores (BS) were calculated as a measure of NSQIP calculator accuracy. Consistent with prior studies, we selected a threshold of BS <0.01 (90% accuracy) as an acceptable calculator. RESULTS We included 567 patients who underwent radical cystectomy, of whom 364 (64%) received an ileal conduit (IC) and 203 (36%) received orthotopic neobladder diversion (ONB). Mean age was 68.24 years (±10.40) and 435 (76%) were male. BS exceeded the threshold of 0.01 (indicating poor predictive value) for serious complications, any complications, surgical site infection, urinary tract infection, deep venous thrombosis, renal failure, readmission, return to operating room, and discharge to rehabilitation facility, regardless of diversion type (see Figure 1) - risk was underestimated for each of these complications. Length of stay was underestimated by 17% and risk of serious complication was underestimated by 31%. The calculator did adequately predict the risk of death for patients receiving ONB and overall. CONCLUSIONS The universal NSQIP surgical risk calculator inaccurately predicts most postoperative complications in patients undergoing radical cystectomy with urinary diversion. This highlights the need for a procedure-specific risk calculator in order to better counsel patients in the preoperative setting and generate realistic quality measures. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1124 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Melanie Adamsky More articles by this author Shay Golan More articles by this author Chuanhong Liao More articles by this author Scott Johnson More articles by this author Nimrod Barashi More articles by this author Raj Bhanvadia More articles by this author Norm Smith More articles by this author Gary Steinberg More articles by this author Arieh Shalhav More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction.

ObjectiveThe National Surgical Quality Improvement Program (NSQIP) calculator was created to improve outcomes and guide cost-effective care in surgery. Patients with head and neck cancer (HNC) undergo ablative and free flap reconstructive surgery with prolonged postoperative courses.MethodsA case series with chart review was performed on 50 consecutive patients with HNC undergoing ablative and reconstructive free flap surgery from October 2014 to March 2016 at a tertiary care center. Comorbidities and intraoperative and postoperative variables were collected. Predicted length of stay was tabulated with the NSQIP calculator.ResultsThirty-five patients (70%) were male. The mean (SD) age was 67.2 (13.4) years. The mean (SD) length of stay (LOS) was 13.5 (10.3) days. The mean (SD) NSQIP-predicted LOS was 10.3 (2.2) days (P = .027).DiscussionThe NSQIP calculator may be an inadequate predictor for LOS in patients with HNC undergoing free flap surgery. Additional study is necessary to determine the accuracy of this tool in this patient population.Implications for Practice:Head and neck surgeons performing free flap reconstructive surgery following tumor ablation may find that the NSQIP risk calculator underestimates the LOS in this population.

Ability of the National Surgical Quality Improvement Program Risk Calculator to Predict Complications Following Total Laryngectomy.

The accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature. To evaluate the accuracy of the calculator's predictions in a single institution's total laryngectomy (TL) population. Total laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism. Comparison of the NSQIP risk calculator's predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis. Of 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67% male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165%, but underestimated surgical site infection by 7%, return to operating room by 24%, and length of stay by 13%. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications. The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient's risk.

Is the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator applicable for breast cancer patients undergoing breast-conserving surgery?

BackgroundWe aimed to analyze the applicability of the National Surgical Quality Improvement Program (NSQIP) calculator to patients undergoing breast-conserving surgery. MethodsA total of 287 consecutive patients treated with breast-conserving surgery from 2010 to 2012 were identified retrospectively. The risk calculator was applied to each patient to generate an individual risk profile. Risk calculations were then compared with actual outcomes. The performance of the risk calculator was evaluated using 2 metrics: the Brier score and c statistic. ResultsThe NSQIP calculator performed adequately for all complications, with Brier scores less than .05. However, 37 patients (12.9%) returned to the operating room for oncologic indications. Twenty-nine patients (10.1%) had positive margins, whereas 8 patients (2.8%) returned due to an upgrade in diagnosis. ConclusionsWhen considering return to the operating room for oncologic management, the observed rate of 13.9% is significantly higher than the NSQIP prediction. This deviation must be addressed when using the NSQIP risk calculator model during preoperative risk discussion.

The National Surgical Quality Improvement Program risk calculator does not adequately stratify risk for patients with clinical stage I non–small cell lung cancer

ObjectiveThe study objective was to validate the National Surgical Quality Improvement Program (NSQIP) Risk Calculator in stratifying risk estimates for patients who received surgery or stereotactic body radiation therapy for clinical stage I non–small cell lung cancer. MethodsA retrospective analysis of patients with clinical stage I non–small cell lung cancer undergoing surgery (N = 279) or stereotactic body radiation therapy (N = 206) from 2009 to 2012 was performed. NSQIP complication risk estimates were calculated for both surgical and stereotactic body radiation therapy cases using the NSQIP Surgical Risk Calculator. NSQIP complication risk estimates were compared as continuous variables and by quartile ranges. ResultsCompared with patients undergoing video-assisted thoracoscopic surgery wedge resection, patients receiving stereotactic body radiation therapy were older, had larger tumors, had lower forced expiratory volume (FEV1) in 1 second and diffusing capacity of the lungs (DLCO) for carbon monoxide values, had higher American Society of Anesthesiologists scores, had higher rates of dyspnea, and had higher NSQIP serious complication risk estimates (all P < .05). Compared with patients undergoing video-assisted thoracoscopic surgery lobectomy, patients receiving stereotactic body radiation therapy had similar disparities, along with higher Adult Comorbidity Evaluation-27 (ACE) scores comorbidity scores, higher rates of cardiac comorbidities, and worse functional status (all P < .05). Variables associated with receiving stereotactic body radiation therapy treatment, rather than wedge resection, included increasing age, higher Adult Comorbidity Evaluation (ACE)-27 comorbidity score, dyspnea status, and decreasing FEV1 in 1 second and DLCO for carbon monoxide, but NSQIP serious complication risk score. In addition, surgical patients' actual serious complication rate (16.6% vs 8.8%) and pneumonia rate (6.0% vs 3.2%) were significantly higher than the NSQIP risk calculator predicted (all P < .05). ConclusionsThe National Surgical Quality Improvement Program risk calculator does not effectively classify or stratify risk in patients with stage I non–small cell lung cancer. Continued efforts are needed to assess risk in this population and develop more tailored treatment decision aids.