Examining the Validity of the Acs-Nsqip Risk Calculator in Plastic Surgery: Lack of Input Specificity, Outcome Variability and Imprecise Risk Calculations

Abstract

American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) created the Surgical Risk Calculator, to allow physicians to offer patients a risk-adjusted 30-day surgical outcome prediction. This tool has not yet been validated in plastic surgery. A retrospective analysis of all plastic surgery-specific complications from a quality assurance database from September 2013 through July 2015 was performed. Patient preoperative risk factors were entered into the ACS Surgical Risk Calculator, and predicted outcomes were compared with actual morbidities. The difference in average predicted complication rate versus the actual rate of complication within this population was examined. Within the study population of patients with complications (n=104), the calculator accurately predicted an above average risk for 20.90% of serious complications. For surgical site infections, the average predicted risk for the study population was 3.30%; this prediction was proven only 24.39% accurate. The actual incidence of any complication within the 4924 patients treated in our plastic surgery practice from September 2013 through June 2015 was 1.89%. The most common plastic surgery complications include seroma, hematoma, dehiscence and flap-related complications. The ACS Risk Calculator does not present rates for these risks. While most frequent outcomes fall into general risk calculator categories, the difference in predicted versus actual complication rates indicates that this tool does not accurately predict outcomes in plastic surgery. The ACS Surgical Risk Calculator is not a valid tool for the field of plastic surgery without further research to develop accurate risk stratification tools.

A Comparative Analysis of Surgical Wound Infection Methods: Predictive Values of the CDC, ASEPSIS, and Southampton Scoring Systems in Evaluating Breast Reconstruction Surgical Site Infections

“…Additional points are awarded for antibiotic treatment, drainage of pus under local anesthesia, debridement of the wound under general anesthesia, isolation of bacteria, and stay as inpatient prolonged over 14 days. Scores are grouped into 4 categories: satisfactory healing (0-10), disturbance of healing (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), minor SSI (21-30), moderate SSI (31-40), and severe SSI (>40). The original ASEPSIS score is meant to evaluate the surgical site for infections from day 5 to 7 postoperatively.…”

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

“…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.…”

Scoping Review of the National Surgical Quality Improvement Program in Plastic Surgery Research

“…It has been argued that the NSQIP poorly estimates complication rates by missing important outcomes including post-operative readmission, infections, and hematomas. 8,62,118 This was reflected in some studies included in this review that directly analyzed the validity of NSQIP as an outcome tool for plastic surgery. This may be attributed to the fact that the NSQIP was created from a disease-specific colorectal risk calculator.…”