Can the American College of Surgeons NSQIP surgical risk calculator identify patients at risk of complications following microsurgical breast reconstruction?

OʼNeill, Anne C.; Bagher, Shaghayegh; Barandun, Marina; Höfer, Stefan; Zhong, Toni

doi:10.1016/j.bjps.2016.05.021

Cited by 32 publications

(27 citation statements)

References 21 publications

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“…We are primarily limited by the size of our study cohort ( n = 107), having few patients with complications (27), and being a single institution retrospective review. The latter two limitations have been implicated by Cohen et al as potential sources of inaccuracy when evaluating the risk calculator [ 11 ]. Specifically, they concluded that three criteria must be met to fairly evaluate the risk calculator: a patient cohort acquired from more than one care center, a minimum of 100 patients with an incidence, and sufficient cohort heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

“…The universal surgical risk calculator created by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was developed as both a surgical aid and informed consent tool to improve the overall decision-making process. The risk calculator is an open-access online tool that uses an algorithm and validated data from over 500 hospitals and 2.7 million operations performed in the Unites States to predict the likelihood of 12 postoperative outcomes [ 7 – 11 ]. This online program accepts the input of 20 comorbidity and demographic-related, patient-specific variables, (such as age group, gender, smoking status, functional status, body-mass index, etc.)…”

Section: Introductionmentioning

confidence: 99%

“…in conjunction with a surgery-specific Current Procedure Terminology (CPT) code, to predict patients’ risk of 12 postoperative outcomes within 30 days after surgery [ 12 , 13 ]. Patient-specific variables chosen for the risk calculator are broadly applicable for patients undergoing one of the 1887 procedures covered [ 11 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Predicting complications of major head and neck oncological surgery: An evaluation of the ACS NSQIP surgical risk calculator

Vosler

Orsini

Enepekides

et al. 2018

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundThe American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) universal surgical risk calculator is an online tool intended to improve the informed consent process and surgical decision-making. The risk calculator uses a database of information from 585 hospitals to predict a patient’s risk of developing specific postoperative outcomes.MethodsPatient records at a major Canadian tertiary care referral center between July 2015 and March 2017 were reviewed for surgical cases including one of six major head and neck oncologic surgeries: total thyroidectomy, total laryngectomy, hemiglossectomy, partial glossectomy, laryngopharyngectomy, and composite resection. Preoperative information for 107 patients was entered into the risk calculator and compared to observed postoperative outcomes. Statistical analysis of the risk calculator was completed for the entire study population, for stratification by procedure, and by utilization of microvascular reconstruction. Accuracy was assessed using the ratio of predicted to observed outcomes, Receiver Operating Characteristics (ROC), Brier score, and the Wilcoxon signed–ranked test.ResultsThe risk calculator accurately predicted the incidences for 11 of 12 outcomes for patients that did not undergo free flap reconstruction (NFF group), but was less accurate for patients that underwent free flap reconstruction (FF group). Length of stay (LOS) analysis showed similar results, with predicted and observed LOS statistically different in the overall population and FF group analyses (p = 0.001 for both), but not for the NFF group analysis (p = 0.764). All outcomes in the NFF group, when analyzed for calibration, met the threshold value (Brier scores < 0.09). Risk predictions for 8 of 12, and 10 of 12 outcomes were adequately calibrated in the FF group and the overall study population, respectively. Analyses by procedure were excellent, with the risk calculator showing adequate calibration for 7 of 8 procedural categories and adequate discrimination for all calculable categories (6 of 6).ConclusionThe NSQIP-RC demonstrated efficacy for predicting postoperative complications in head and neck oncology surgeries that do not require microvascular reconstruction. The predictive value of the metric can be improved by inclusion of several factors important for risk stratification in head and neck oncology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predicting complications of major head and neck oncological surgery: An evaluation of the ACS NSQIP surgical risk calculator

Vosler

Orsini

Enepekides

et al. 2018

Journal of Otolaryngology - Head & Neck Surgery

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“…13 Although this databasehas been applied across surgical subspecialties, there are concerns over its 30-day postoperative window and the possibility of it underrepresenting the entirety of complications a patient can experience in the postoperative period. 14,15 We recently published results on infectious readmission rates in patients who underwent implant-based breast reconstruction. We found that 50.7% of infectious readmissions occurred between a 31-and 90-day postoperative period, leading us to conclude that traditional 30-day readmission rates were inadequate to track that specific patient population.…”

mentioning

confidence: 99%

A Nationwide Analysis of Early and Late Readmissions following Free Tissue Transfer for Breast Reconstruction

Magno-Padron

Collier

Kim

et al. 2020

J Reconstr Microsurg

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Background Traditionally, surgical quality outcomes are assessed using a 30-day postoperative window. For breast cancer patients undergoing free tissue transfer for breast reconstruction, we sought to describe the distribution of and specific risk factors for early and late readmissions within a 0- to 90-day postoperative period. Patients and Methods The Nationwide Readmissions Database was used to conduct a retrospective cohort study. Breast cancer patients undergoing free tissue transfer for breast reconstruction were identified using International Classification of Diseases -9 diagnosis and procedure codes. Ninety-day readmissions related to infection or wound complications were identified. Univariable and multivariable logistic regression models were used to identify patient risk factors for readmissions that occurred early (0–30 days) and late (31–90 days) after their index procedure. Results In the weighted sample, we identified approximately 7,305 free flap breast reconstructions and a surgical wound-related readmission rate of 4.3% (n = 312): 65.4% of the readmissions occurred early while 34.6% occurred late after surgery. The mean days to readmission was 26, and 75% of all readmissions occurred within the first 36 days after surgery. Variables independently associated with readmissions during the 0- to 90-day postoperative period included: history of chronic obstructive pulmonary disease (p = 0.036), hypertension (p = 0.03), obesity (p ≤ 0.001), and history of smoking (p = 0.004). The variables independently associated with the early readmission period were the same as those identified for the 0- to 90-day postoperative period. The variables independently associated with late readmissions were different: history of depression (p = 0.001) and history of smoking (p = 0.001). Conclusion The conventional 30-day hospital readmission rate classically used as a quality metric is overlooking a significant portion of admissions after free flap-based breast reconstruction. Different variables were found to be associated with readmission in the early versus late cohorts. Interventions targeting these variables could decrease readmissions and their associated costs.

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“…(4) The database contains preoperative and intraoperative variables which have been used to devise a surgical risk calculator (SRC). (5) The SRC has shown mixed results in predicting postoperative complications in different surgical populations (6,7) and this discordance could, in part, be due to varying effect of the included predictors. The aim of this retrospective cohort study is to identify the role of individual contributors of the ACS NSQIP ® SRC in impacting postoperative mortality in patients undergoing a wide array of non-cardiac surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) database to identify factors associated with postoperative mortality after elective non-cardiac surgery

Malviya¹,

Bruceta²,

Singh³

et al. 2020

Preprint

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Background Various surgical risk assessment tools, including the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) risk calculator have been devised to predict post-operative mortality. However, the role of individual factors on mortality is unclear. We sought to identify patient characteristics from the database that were associated with postoperative mortality in patients undergoing elective, non-cardiac surgery.Methods Data from the ACS NSQIP® database at a tertiary care academic medical center was analyzed from January 2011 to September 2016. Relevant patient related variables were extracted from the database and univariable logistic regression was used to assess the association of each potential risk factor with 30-day mortality. A multivariable logistic regression model was then used to assess the adjusted effect of each potential risk factor on the outcome.Results 5,254 database patient records were identified and among the analyzed variables, American Society of Anesthesiologists (ASA) physical status III and IV (odds ratio and 95%CI : 16.75 [2.29, 122.69] ), poor preoperative functional health status (Odds ratio and 95%CI : 38.52 [2.46, 604.12] ), and low serum albumin (Odds ratio and 95%CI : 3.76 [1.35, 10.44]) were significant predictors of 30-day postoperative mortality.Conclusions In a comprehensive analysis of the ACS NSQIP®database, spreading across multiple surgical specialties, we found an association between ASA physical status, preoperative albumin levels, and functional health status with 30-day mortality after elective non-cardiac surgery.

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Can the American College of Surgeons NSQIP surgical risk calculator identify patients at risk of complications following microsurgical breast reconstruction?

Cited by 32 publications

References 21 publications

Predicting complications of major head and neck oncological surgery: An evaluation of the ACS NSQIP surgical risk calculator

Predicting complications of major head and neck oncological surgery: An evaluation of the ACS NSQIP surgical risk calculator

A Nationwide Analysis of Early and Late Readmissions following Free Tissue Transfer for Breast Reconstruction

Analysis of the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) database to identify factors associated with postoperative mortality after elective non-cardiac surgery

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