Evaluation of the performance of the ACS NSQIP surgical risk calculator in gynecologic oncology patients undergoing laparotomy

Abstract

Objective The objective of this study was to evaluate the ability of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator to predict complications in gynecologic oncology patients undergoing laparotomy. Methods A chart review of patients who underwent laparotomy on the gynecologic oncology service at a single academic hospital from January 2009 to December 2013 was performed. Preoperative variables were abstracted and NSQIP surgical risk scores were calculated. The risk of any complication, serious complication, death, urinary tract infection, venous thromboembolism, cardiac event, renal complication, pneumonia and surgical site infection were correlated with actual patient outcomes using logistic regression. The c-statistic and Brier score were used to calculate the prediction capability of the risk calculator. Results Of the 1,094 patients reviewed, the majority were <65 years old (70.9%), independent (95.2%), ASA class 1-2 (67.3%), and overweight or obese (76.1%). Higher calculated risk scores were associated with an increased risk of the actual complication occurring for all events (p<0.05). The calculator performed best for predicting death (c-statistic=0.851, Brier=0.008) and cardiac complications (c-statistic=0.708, Brier=0.011). The calculator did not accurately predict most complications. Conclusions The NSQIP surgical risk calculator adequately predicts specific serious complications, such as postoperative death and cardiac complications. However, the overall performance of the calculator was worse for gynecologic oncology patients than reported in general surgery patients. A tailored prediction model may be needed for this patient population.

Prediction model for 30-day morbidity after gynecological malignancy surgery

“…However, the aforementioned models cannot reliably be used in gynecological oncology [21,23,24]. Apparently, the risk factors for postoperative morbidity differs based on the surgical sites and the type of procedures [7].…”

Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline

“…However, a recent study in a gynecologic oncology population demonstrated that the calculator was able to predict the risk of death and cardiac complications, but was not accurate for other surgical complications. 29 The SGO/ASCO Panel looks forward to reviewing validated and tested, user-friendly risk prediction tools when they are available, but at present, none can be fully recommended.…”

Endometrial cancer in an increasingly obese population: Exploring alternative options when surgery may not cut it

“…For our cohort, we looked at the ACS NSQIP surgical risk calculator. Although the NSQIP surgical risk calculator has been shown to adequately predict specific serious complications, the overall performance of the calculator may be less accurate in gynecologic oncology patients than reported in general surgery patients, suggesting the need for a tailored prediction model in our population ( Rivard et al, 2016 ). In our small cohort, who were deemed medically inoperable and progressed following initial treatment and were treated surgically, the mortality rate was 12.5% (1/8); again, small numbers limit any conclusions.…”