NSQIP Surgical Risk Calculator Research Articles

A comparative assessment of ACS NSQIP-predicted and actual surgical risk outcomes of robotic transhiatal esophagectomy for esophageal adenocarcinoma resection at a high volume institution.

Esophageal adenocarcinoma incidence is increasing in Western nations. There has been a shift toward minimally invasive approaches for transhiatal esophagectomy (THE). This study compares the outcomes of robotic THE for esophageal adenocarcinoma resection at our institution with the predicted metrics from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). With Institutional Review Board (IRB) approval, we prospectively followed 83 patients who underwent robotic THE from 2012 to 2023. Predicted outcomes were determined using the ACS NSQIP Surgical Risk Calculator. Our outcomes were compared with these predicted outcomes and with general outcomes for transhiatal esophagectomy reported in ACS NSQIP, which includes a mix of surgical approaches. The median age of patients was 70years, with a body mass index (BMI) of 26.4kg/m2 and a male prevalence of 82%. The median length of stay was 7days. The rates of any complications and in-hospital mortality were 16% and 5%, respectively. Seven patients (8%) were readmitted within a 30-day postoperative window. The median survival is anticipated to surpass 95months. Our outcomes were generally aligned with or surpassed the predicted ACS NSQIP metrics. The extended median survival of over 95months highlights the potential effectiveness of robotic THE in the resection of esophageal adenocarcinoma. Further exploration into its long-term survival benefits and outcomes is warranted, along with studies that provide a more direct comparison between robotic and other surgical approaches.

Validity of the ACS NSQIP surgical risk calculator as a tool to predict postoperative outcomes in subacute orthopedic trauma diagnoses

PurposeThis retrospective study aimed to validate the ACS NSQIP Surgical Risk Calculator (SCR) to predict 30-day postoperative outcomes in patients with one of the following subacute orthopedic trauma diagnoses; multiple rib fractures, pelvic ring/acetabular fracture, or unilateral femoral fracture. MethodsData of patients with these diagnoses treated between January 1, 2015 and September 19, 2020 were extracted from the patients’ medical files. Diagnostic performance, discrimination, calibration, and accuracy of the ACS NSQIP SRC to predict specific outcomes developing within 30 days after surgery was determined. ResultsThe total cohort of the three diagnoses consisted of 435 patients. ACS NSQIP SRC underestimated the risk for serious complications, especially in patients with multiple rib fractures (8.3% predicted vs 17.2% observed) or pelvic ring/acetabular fracture (6.1% vs 19.8%). Underestimation was more pronounced for the composite outcome ‘any complication’. Sensitivity ranged from 16.7% to 100% and specificity from 41.1% to 97.1%. Specificity exceeded sensitivity for pelvic ring/acetabular and femoral fractures. Discrimination was good for predicting death (femoral fracture), fair for readmission (femoral fracture), serious complication (multiple rib fractures), and any complication (multiple rib fractures), but poor in all other outcomes and diagnoses. Calibration and accuracy were adequate for all three diagnoses (p-value for Hosmer-Lemeshow test >0.05 and Brier scores <0.25). ConclusionPerformance of the ACS NSQIP SRC in the studied cohort was variable for all three diagnoses. Although it underestimated the risk of most outcomes, calibration and accuracy seemed generally adequate. For most outcomes, adequate diagnostic performance and discrimination could not be confirmed.

Evaluating the predictive value of NSQIP surgical risk calculator in patients undergoing emergency laparoscopic cholecystectomy at a single UK centre

Evaluating the predictive value of NSQIP surgical risk calculator in patients undergoing emergency laparoscopic cholecystectomy at a single UK centre

Evaluation of the ACS NSQIP surgical risk calculator in patients undergoing common bile duct exploration.

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is a risk stratification tool to help predict risks of postoperative complications, which is important for informed decision-making. The purpose of this study was to evaluate the accuracy of the calculator in predicting postoperative complications in patients undergoing common bile duct (CBD) exploration. A retrospective chart review was completed for 305 patients that underwent open and laparoscopic CBD exploration at a single institution from 2010 to 2018. Patient demographics and preoperative risk factors were entered into the calculator, and the predicted complication risks were compared with observed complication rates. Brier score, C-statistic, and Hosmer-Lemeshow regression analysis were used to assess discrimination and calibration. The observed rate exceeded the predicted rate for any complication (35.1% vs. 21%), return to operating room (5.9% vs. 3.6%), death (3.3% vs. 1%), and sepsis (3% vs. 2.4%). The model performed best in predicting serious complication (Brier 0.087, C-statistic 0.818, Hosmer-Lemeshow 0.695), surgical site infection (Brier 0.068, C-statistic 0.670, Hosmer-Lemeshow 0.292), discharge to rehabilitation facility (Brier 0.041, C-statistic 0.907, Hosmer-Lemeshow 0.638), and death (Brier 0.028, C-statistic 0.898, Hosmer-Lemeshow 0.004). In multivariable analysis, there was no statistically significant predicted complication type that affected the type of surgery. The calculator was accurate in predicting serious complication, surgical site infection, discharge to rehabilitation facility, and death. However, the model displayed poor predictive ability in all other complications that were analyzed.

Accuracy of the ACS NSQIP Surgical Risk Calculator for Predicting Postoperative Complications in Gastric Cancer Following Open Gastrectomy.

The prediction of complications before gastric surgery is of utmost importance in shared decision making and proper counseling of the patient in order to minimize postoperative complications. Our aim was to evaluate the predictive validity of American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator in gastric cancer patients who underwent gastrectomy. Preoperative assessment data of 432 patients were retrospectively reviewed and manually entered into the calculator. The accuracy of the calculator was evaluated using Pearson's chi-squared test, C-statistic, Brier score, and Hosmer-Lemeshow test. The lowest Brier scores were observed in urinary tract infection, renal failure, venous thromboembolism, pneumonia, and cardiac complications. Best results were obtained for predicting sepsis, discharge to rehabilitation facility, and death (low Brier scores, C-statistic >.7, and Hosmer-Lemeshow P > .05). The calculator had a strong performance in predicting sepsis, discharge to the rehabilitation facility, and death. However, it performed poor in predicting the most commonly observed events (any or serious complication and surgical site infection).

Predicting Severe Complications from Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy: A Data-Driven, Machine Learning Approach to Augment Clinical Judgment.

CRS-HIPEC provides oncologic benefit in well-selected patients with peritoneal carcinomatosis; however, it is a morbid procedure. Decision tools for preoperative patient selection are limited. We developed a risk score to predict severity of 90day complications for cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Adults who underwent CRS-HIPEC at the University of Pittsburgh Medical Center (March 2001-April 2020) were analyzed as part of this study. Primary endpoint was severe complications within 90days following CRS-HIPEC, defined using Comprehensive Complication Index (CCI) scores as a dichotomous (determined using restricted cubic splines) and continuous variable. Data were divided into training and test sets. Several machine learning and traditional algorithms were considered. For the 1959 CRS-HIPEC procedures included, CCI ranged from 0 to 100 (median 32.0). Adjusted restricted cubic splines model defined severe complications as CCI > 61. A minimum of 20 variables achieved optimal performance of any of the models. Linear regression achieved the highest area under the receiving operator characteristic curve (AUC, 0.74) and outperformed the NSQIP Surgical Risk calculator (AUC 0.80 vs. 0.66). Factors most positively associated with severe complications included peritoneal carcinomatosis index score, symptomatic status, and undergoing pancreatectomy, while American Society of Anesthesiologists 2 class, appendiceal diagnosis, and preoperative albumin were most negatively associated with severe complications. This study refines our ability to predict severe complications within 90days of discharge from a hospitalization in which CRS-HIPEC was performed. This advancement is timely and relevant given the growing interest in this procedure and may have implications for patient selection, patient and referring provider comfort, and survival.

Current use of the National Surgical Quality Improvement Program surgical risk calculator in academic surgery: a mixed-methods study.

This study aims to quantitatively assess use of the NSQIP surgical risk calculator (NSRC) in contemporary surgical practice and to identify barriers to use and potential interventions that might increase use. We performed a cross-sectional study of surgeons at seven institutions. The primary outcomes were self-reported application of the calculator in general clinical practice and specific clinical scenarios as well as reported barriers to use. In our sample of 99 surgeons (49.7% response rate), 73.7% reported use of the NSRC in the past month. Approximately half (51.9%) of respondents reported infrequent NSRC use (<20% of preoperative discussions), while 14.3% used it in ≥40% of preoperative assessments. Reported use was higher in nonelective cases (30.2% vs 11.1%) and in patients who were ≥65 years old (37.1% vs 13.0%), functionally dependent (41.2% vs 6.6%), or with surrogate consent (39.9% vs 20.4%). NSRC use was not associated with training status or years in practice. Respondents identified a lack of influence on the decision to pursue surgery as well as concerns regarding the calculator's accuracy as barriers to use. Surgeons suggested improving integration to workflow and better education as strategies to increase NSRC use. Many surgeons reported use of the NSRC, but few used it frequently. Surgeons reported more frequent use in nonelective cases and frail patients, suggesting the calculator is of greater utility for high-risk patients. Surgeons raised concerns about perceived accuracy and suggested additional education as well as integration of the calculator into the electronic health record.

Impact of Prehabilitation on Postoperative Mortality and the Need for Non-Home Discharge in High-Risk Surgical Patients.

The preoperative period is an important target for interventions (eg Surgical Prehabilitation and Readiness [SPAR]) that can improve postoperative outcomes for older patients with comorbidities. To determine whether a preoperative multidisciplinary prehabilitation program (SPAR) reduces postoperative 30-day mortality and the need for non-home discharge in high-risk surgical patients, surgical patients enrolled in a prehabilitation program targeting physical activity, pulmonary function, nutrition, and mindfulness were compared with historical control patients from 1 institution's American College of Surgeons (ACS) NSQIP database. SPAR patients were propensity score-matched 1:3 to pre-SPAR NSQIP patients, and their outcomes were compared. The ACS NSQIP Surgical Risk Calculator was used to compare observed-to-expected ratios for postoperative outcomes. A total of 246 patients were enrolled in SPAR. A 6-month compliance audit revealed that overall patient adherence to the SPAR program was 89%. At the time of analysis, 118 SPAR patients underwent surgery with 30 days of follow-up. Compared with pre-SPAR NSQIP patients (n = 4,028), SPAR patients were significantly older with worse functional status and more comorbidities. Compared with propensity score-matched pre-SPAR NSQIP patients, SPAR patients had significantly decreased 30-day mortality (0% vs 4.1%, p = 0.036) and decreased need for discharge to postacute care facilities (6.5% vs 15.9%, p = 0.014). Similarly, SPAR patients exhibited decreased observed 30-day mortality (observed-to-expected ratio 0.41) and need for discharge to a facility (observed-to-expected ratio 0.56) compared with their expected outcomes using the ACS NSQIP Surgical Risk Calculator. The SPAR program is safe and feasible and may reduce postoperative mortality and the need for discharge to postacute care facilities in high-risk surgical patients.

Surgical mortality in patients in extremis: futility in emergency abdominal surgery

BackgroundThe number of older patients with multiple comorbidities in the emergency service is increasingly frequent, which implies the risk of incurring in futile surgical interventions. Some interventions generate false expectations of survival or quality of life in patients and families and represent a negligible therapeutic benefit in patients whose chances of survival are minimal. In order to address this dilemma, we describe mortality in a cohort of patients undergoing emergency laparotomy with a risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator.MethodsA retrospective observational study was designed to analyze postoperative mortality and factors associated with postoperative mortality in a cohort of patients undergoing emergency laparotomy between January 2018 and December 2021 in a high-complexity hospital who had a mortality risk ≥ 75% per the ACS NSQIP Surgical Risk Calculator.ResultsA total of 890 emergency laparotomies were performed during the study period, and 50 patients were included for the analysis. Patient median age was 82.5 (IQR: 18.25) years old and 33 (66.00%) were male. The most frequent diagnoses were mesenteric ischemia 21 (42%) and secondary peritonitis 18 (36%). Mortality in the series was 92%. Twenty-four (54.34%) died within the first 24 h of the postoperative period; 11 (23.91%) within 72 h and 10 (21.73%) within 30 days. APACHE II and SOFA scores were statistically significantly higher in patients who died.ConclusionsAll available tools should be used to make decisions, with the most reliable and objective information possible, and be particularly vigilant in patients at extreme risk (mortality risk greater than 75% according to ACS NSQIP Surgical Risk Calculator) to avoid futility and its consequences. The available information should be shared with the patient, the family, or their guardians through an assertive and empathetic communication strategy. It is necessary to insist on a culture of surgical ethics based on reflection and continuous improvement in patient care and to know how to accompany them in order to have a proper death.

What If We Do Not Operate? Outcomes of Nonoperatively Managed Emergency General Surgery Patients

IntroductionAlthough two-thirds of patients with emergency general surgery (EGS) conditions are managed nonoperatively, their long-term outcomes are not well described. We describe outcomes of nonoperative management in a cohort of older EGS patients and estimate the projected risk of operative management using the NSQIP Surgical Risk Calculator (SRC). Materials and methodsWe studied single-center inpatients aged 65 y and more with an EGS consult who did not undergo an operation (January 2019-December 2020). For each patient, we recorded the surgeon's recommendation as either an operation was “Not Needed” (medical management preferred) or “Not Recommended” (risk outweighed benefits). Our main outcome of interest was mortality at 30 d and 1 y. Our secondary outcome of interest was SRC-projected 30-day postoperative mortality risk (median % [interquartile range]), calculated using hypothetical low-risk and high-risk operations. ResultsWe included 204 patients (60% female, median age 75 y), for whom an operation was “Not Needed” in 81% and “Not Recommended” in 19%. In this cohort, 11% died at 30 d and 23% died at 1 y. Mortality was higher for the “Not Recommended” cohort (37% versus 5% at 30 d and 53% versus 16% at 1 y, P < 0.05). The SRC-projected 30-day postoperative mortality risk was 3.7% (1.3-8.7) for low-risk and 5.8% (2-11.8) for high-risk operations. ConclusionsNonoperative management in older EGS patients is associated with very high risk of short-term and long-term mortality, particularly if a surgeon advised that risks of surgery outweighed benefits. The SRC may underestimate risk in the highest-risk patients.

ACS-NSQIP – Surgical risk calculator accurately predicts outcomes of laparotomy in a prospective study at a tertiary hospital in Tanzania

Introduction: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is excellent in predicting postoperative complications. Validation in resource-limited settings and applicability in gastrointestinal surgery is still unclear. Objective: The study aimed to determine the accuracy of the ACS-NSQIP surgical risk calculator in predicting the 30days postoperative adverse outcomes among patients who underwent laparotomy. Methods: A Single hospital-based, prospective cohort study was done at Muhimbili National Hospital in Tanzania from April 2021 to December 2021 recruiting patients aged 18 and above who underwent primary laparotomy. SR calculator variables were obtained from patients and entered manually to categorize patients into low and high-risk. Patients were followed up for thirty days for the outcome. The predicted risk was compared with actual occurrence to obtain personal risk ratios. The c-statistics of &gt; 0.7, Brier of score &lt; 0.25 and Index of Prediction Accuracy score were used for discrimination, accuracy, and usefulness of the model respectively. Results: ACS -NSQIP SR-Calculator discriminated well the risks of cardiac complications, re-laparotomy, Anastomotic leak, and death (c-statistic &gt; 0.7) Poor discrimination was observed for the length of hospital stay (c-statistics 0.518). However, SR-calculator shows high calibration potential for all complications with a Brier score &lt; 0.25 (0.002 - 0.144) and an IPA score ranging from 0.225 - 0.969. Conclusion: The ACS -NSQIP SR-calculator accurately predicted postoperative outcomes for patients requiring laparotomy. SR-Calculator is a reliable tool for preoperative shared decision-making and counseling. The model should be adopted to strengthen the healthcare system in a low-income country. What is already known about this subject?  The ACS NSQIP surgical risk calculator is accurate in predicting the outcome of the Surgical procedure.  ACS NSQIP surgical risk calculator was validated in the USA  The SRC is associated with surgical care improvement whenever applied. What are the new findings?  The SRC accurately predicted the 30-day outcomes associated with primary laparotomy except for the length of hospital stay, discharge for other services, and veno-thromboembolic events.  The risk ratio (RR) provides a preliminary estimation of specific complications for a single patient.  Index of prediction Accuracy (IPA) reliably summarizes the discrimination and calibration of the ACS-NSQIP-SR-Calculator.  The SRC can be validated in a resource-limited setting and can be a source of surgical care improvement. How might these results affect future research or surgical practice?  The results of this study will provide a comparison between our institution and other international situations where a calculator had been tested and surgical service improvement locally. Our findings will provide insights into our loco-regional surgical institutions in the low-income country to conduct cross-specialties and institutional research toward the adoption of ACS-NSQIP-SRC into National surgical improvement programs. Informative to the surgical community on the performance of the SR-calculator outside the USA.

Risk Prediction for Complications in Inflammatory Bowel Disease Surgery: External Validation of the American College of Surgeons' National Surgical Quality Improvement Program Surgical Risk Calculator.

Many patients with inflammatory bowel disease [IBD] require surgery during their disease course. Having individual risk predictions available prior to surgery could aid in better informed decision making for personalised treatment trajectories in IBD surgery. The American College of Surgeons National Surgical Quality Improvement Program [ACS NSQIP] has developed a surgical risk calculator that calculates risks for postoperative outcomes using 20 patient and surgical predictors. We aimed to validate the calculator for IBD surgery to determine its accuracy in this patient cohort. Predicted risks were calculated for patients operated for IBD between December 2017 and January 2022 at two tertiary centres and compared with actual outcomes within 30 postoperative days. Predictive performance was assessed for several postoperative complications, using metrics for discrimination and calibration. Risks were calculated for 508 patient trajectories undergoing surgery for IBD. Incidence of any complication, serious complications, reoperation, and readmission were 32.1%, 21.1%, 15.2%, and 18.3%, respectively. Of 212 patients with an anastomosis, 19 experienced leakage [9.0%]. Discriminative performance and calibration were modest. Risk prediction for any complication, serious complication, reoperation, readmission, and anastomotic leakage had a c statistic of 0.605 (95% confidence interval [CI] 0.534-0.640), 0.623 [95% CI 0.558-0.688], 0.590 [95% CI 0.513-0.668], 0.621 [95% CI 0.557-0.685], and 0.574 [95% CI 0.396-0.751], respectively, and a Brier score of 0.240, 0.166, 0.138, 0.152, and 0.113, respectively. The accuracy of risks calculated by the ACS NSQIP Surgical Risk Calculator was deemed insufficient for patients undergoing surgery for IBD, generally underestimating postoperative risks. Recalibration or additional variables could be necessary to predict risks in this cohort.

Validation of the ACS NSQIP surgical risk calculator in older patients with colorectal cancer undergoing elective surgery

BackgroundFor clinical decision making it is important to identify patients at risk for adverse outcomes after colorectal cancer (CRC) surgery, especially in the older population. Because the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is potentially useful in clinical practice, we performed an external validation in a Dutch multicenter cohort of patients ≥70 years undergoing elective non-metastatic CRC surgery. MethodsWe compared the ACS NSQIP calculator mean predicted risk to the overall observed rate of anastomotic leakage, return to operation room, pneumonia, discharge not to home, and readmission in our cohort using a one-sample Z-test. Calibration plots and receiver operating characteristic (ROC) curves were used to determine the calculator's performance. ResultsSix hundred eighty-two patients were included. Median age was 76.2 years. The ACS NSQIP calculator accurately predicted the overall readmission rate (predicted: 8.6% vs. observed: 7.8%, p = 0.456), overestimated the rate of discharge not to home (predicted:11.2% vs. observed: 7.0% p = 0.005) and underestimated the observed rate of all other outcomes. The calibration plots showed poor calibration for all outcomes. The ROC-curve showed an area under the curve (AUC) of 0.75 (95% confidence interval [CI] 0.67–0.83) for pneumonia and 0.70 (0.62–0.78) for discharge not to home. The AUC for all other outcomes was poor. ConclusionsThe ACS NSQIP surgical risk calculator had a poor individual risk prediction (calibration) for all outcomes and only a fair discriminative ability (discrimination) to predict pneumonia and discharge not to home. The calculator might be considered to identify patients at high risk of pneumonia and discharge not to home to initiate additional preoperative interventions.

Precisión de la calculadora de riesgo quirúrgico ACS NSQIP para predecir morbilidad y mortalidad en pacientes mexicanos.

American College of Surgeons (ACS) developed the ACS NSQIP surgical risk calculator that predicts the results of elective and emergency surgical procedures. This tool has been useful improving the morbidity and mortality in hospitals in the United States and Canada. To evaluate the usefulness of the ACS NSQIP risk calculator for predicting postoperative complications in Mexican population. Prospective, observational, analytical study. Patients undergoing abdominal surgery were recorded, 21 preoperative variables were captured and entered into the calculator. They were followed up to 30 days postoperatively, identifying 14 types of postoperative complications. 109 patients were registered. A comparison was made between the calculated and observed complications, obtaining a good correlation in the complications of cardiac arrest, surgical site infection, reoperation, sepsis and mortality (p < 0.05). ACS NSQIP risk calculator is useful in the Mexican population, since the score obtained predicts most postoperative complications including mortality. The use of this tool offers an opportunity to improve decision-making in the care of the surgical patient.

Geriatric patient outcomes in a multidisciplinary central nervous system community hospital clinic for radiation oncology and neurosurgery (RADIANS)

IntroductionManagement of older adult patients with central nervous system (CNS) cancers requires a patient-centric, multidisciplinary approach. Assessment of neurosurgical and radiation treatment outcomes can assist in establishing guidelines for this patient population. We previously reported on the RADIANS clinic, a novel community hospital-based multidisciplinary clinic (MDC) for CNS cancer care, providing simultaneous radiation oncology and neurosurgery evaluation in a same-day, single-setting clinic. We now provide a focused analysis of our older adult patient population and recommendations for triage and standardization of care. MethodsConsecutive older adult patients (age ≥ 65) evaluated at the RADIANS clinic for CNS disease were identified and retrospectively reviewed. Observed 30-day neurosurgical outcomes were compared to predicted outcomes determined by the American College of Physicians NSQIP Surgical Risk Calculator. One-sample binomial exact tests were used to evaluate binary outcome measures. A two-sample t-test was used to evaluate the length of hospital stay. Brier Scores were calculated to assess the deviation between predicted probabilities and observed outcomes for binary outcome measures. Overall survival at 90 days was reported. ResultsFifty-six older adult patients with malignant (42/56) and benign (14/56) CNS disease were evaluated. Mean distance traveled for multidisciplinary evaluation at the RADIANS clinic was 43.4 miles. There was no incidence of radiation-induced toxicity. Mean length of hospital stay for RADIANS patients was significantly shorter by about 1.5 to 3.5 days (95% CI). There was no statistically significant difference for other outcome measures, however, Brier Scores demonstrated that NSQIP was not a good predictive tool for any or serious complications, UTI, venous thromboembolism, return to OR, readmission, or death in our cohort. Local tumor control rate and progression-free survival at 90 days were 97.4% and 76.9%, respectively. ConclusionsThis is the first report of CNS disease outcomes in older adult patients evaluated by radiation oncology and neurosurgery at a community hospital-based MDC. We observed minimal adverse radiation outcomes and high tumor control in our cohort. Findings show significantly shorter postoperative hospital stay for patients evaluated and managed at the RADIANS clinic.

SIOG2021-0054* - Validation of the ACS NSQIP Surgical Risk Calculator in older patients with colorectal cancer undergoing elective surgery

SIOG2021-0054* - Validation of the ACS NSQIP Surgical Risk Calculator in older patients with colorectal cancer undergoing elective surgery

Evaluating the Inaccuracy of the NSQIP Surgical Risk Calculator in Predicting 30-day Complications in Plastic Surgery

Evaluating the Inaccuracy of the NSQIP Surgical Risk Calculator in Predicting 30-day Complications in Plastic Surgery

83. External validation of the NSQIP calculator utilizing a single institutional experience for adult spinal deformity corrective surgery

<h3>BACKGROUND CONTEXT</h3> NSQIP Surgical Risk Calculator is a web-based decision aid and informed consent tool widely used by surgeons and their patients. This application creates patient-specific risks for those planning to undergo a procedure. Despite its wide use, minimal studies have validated the external applicability of the NSQIP calculator, in the setting of adult spinal deformity. <h3>PURPOSE</h3> Identify NSQIP risk calculator usability in a population of adult spinal deformity (ASD) patients from a single institution database (Quality). <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study of patients with adult spinal deformity between 2011-2018. <h3>PATIENT SAMPLE</h3> Adult spinal deformity patients. <h3>OUTCOME MEASURES</h3> Any Complication rate, cardiac complication, SSI, UTI, return to OR and length of stay (LOS). <h3>METHODS</h3> ASD patients were isolated in Quality (2011-2018). CPT codes for ASD patients were utilized in the NSQIP calculator in order to create baseline expectations for patient outcomes. 7 variables shared among Quality and NSQIP risk calculator were identified for average predictive values. The same perioperative outcomes collected from the NSQIP calculator was then analyzed in the Quality database. Pts were further stratified by frailty (not frail [NF]<0.03, frail[F] 0.3-0.5, severely frail [SF]>0.5). Brier scores were calculated for each variable in order to validate the calculator's predictability in Quality. Having a score closer to 1 means the NSQIP calculator is not predictive of that specific outcome. A score closer to 0 means the NSQIP calculator was a predictive tool for that factor. <h3>RESULTS</h3> A total of 1,606 ASD patients were isolated from the Quality (48.7yrs, 63.8%F, 25.8 kg/m2). 33.4% received decompressions and 100% received a fusion. Of these Quality patients, 15.1% had past medical history of hypertension, 3.1% malignant cancer, 5.2% diabetes, 2.6% connective tissue disease and 2.8% chronic pulmonary disease. The average ASD outcome predicted by the NSQIP risk calculator predicted lower rates for NSQIP patients for return to OR (0.8% vs 2.4%), LOS (2.5d vs 6.5d), total complication rate (11.5% vs 16.5%), and cardiac (0.34% vs 1.9%) than Quality patients. The single institution did have lower UTI and SSI outcomes (1.7% vs 2.85%; 1% vs 1.8% respectively). The calculated Brier scores identified the calculator's predictability for each factor: complication total (0.78), cardiac (0.99), SSI (0.99), UTI (0.96), and return to OR (0.92). The only variable predictive among ASD patients was death with a Brier score of 0 in both groups. This was also the only factor among NF patients (Brier score:0). The NSQIP calculator predicted outcomes for F patients that were lower than those identified in the single institution and therefore, didn't have much usability in this population. <h3>CONCLUSIONS</h3> The NSQIP calculator is not a valid calculator in our single institutional database. It is unable to comment on surgical complications such as return to OR, SSI, UTI and cardiac that are typically associated with poor patient outcomes. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Validation study of the ACS NSQIP surgical risk calculator for two procedures in Japan

IntroductionThe ACS NSQIP Surgical Risk Calculator (SRC) assesses risk to support goal-concordant care. While it accurately predicts US outcomes, its performance internationally is unknown. This study evaluates SRC accuracy in predicting mortality following low anterior resection (LAR) and pancreaticoduodenectomy (PD) in NSQIP patients and accuracy retention when applied to native Japanese patients (National Clinical Database, NCD). MethodsNSQIP (41,260 LAR; 15,114 PD) and NCD cases (61,220 LAR; 27,901 PD) from 2015 to 2017 were processed through the SRC mortality model. Country-specific calibration and discrimination were assessed with and without an intercept correction applied to the Japanese data. ResultsThe SRC exhibited acceptable calibration for LAR and PD when applied to NSQIP data but miscalibration for NCD data. A simple correction to the model intercept, motivated by lower mortality rates in the Japanese data, successfully remediated the miscalibration. ConclusionsThe SRC may inaccurately predict surgical risk when applied to the native Japanese population. An intercept correction method is suggested when miscalibration is encountered; it is simple to implement and may permit effective international use of the SRC.

Does the ACS NSQIP Surgical Risk Calculator Accurately Predict Complications Rates After Anterior Lumbar Interbody Fusion Procedures?

Clinical case series. The aim of this study was to determine the effectiveness of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator in the prediction of complications after anterior lumbar interbody fusion (ALIF). Identifying at-risk patients may aid in the prevention of complications after spine procedures. The ACS NSQIP surgical risk calculator was developed to predict 30-day postoperative complications for a variety of operative procedures. Medical records of patients undergoing ALIF at our institution from 2009 to 2019 were retrospectively reviewed. Demographic and comorbidity variables were entered into the ACS NSQIP surgical risk calculator to generate percentage predictions for complication incidence within 30 days postoperatively. The observed incidences of these complications were also abstracted from the medical record. The predictive ability of the ACS NSQIP surgical risk calculator was assessed in comparison to the observed incidence of complications using area under the curve (AUC) analyses. Two hundred fifty-three (253) patients were analyzed. The ACS NSQIP surgical risk calculator was a fair predictor of discharge to non-home facility (AUC 0.71) and surgical site infection (AUC 0.70). The ACS NSQIP surgical risk calculator was a good predictor of acute kidney injury/progressive renal insufficiency (AUC 0.81). The ACS NSQIP surgical risk calculator was not an adequate predictive tool for any other category, including: pneumonia, urinary tract infections, venous thromboembolism, readmission, reoperations, and aggregate complications (AUC < 0.70). The ACS NSQIP surgical risk calculator is an adequate predictive tool for a subset of complications after ALIF including acute kidney injury/progressive renal insufficiency, surgical site infections, and discharge to non-home facilities. However, it is a poor predictor for all other complication groups. The reliability of the ACS NSQIP surgical risk calculator is limited, and further identification of models for risk stratification is necessary for patients undergoing ALIF.Level of Evidence: 3.