Retroperitoneal sarcoma perioperative risk stratification: A United States Sarcoma Collaborative evaluation of the ACS‐NSQIP risk calculator

Abstract

BackgroundThe ACS‐NSQIP risk calculator predicts perioperative risk. This study tested the calculator's ability to predict risk for outcomes following retroperitoneal sarcoma (RPS) resection.MethodsThe United States Sarcoma Collaborative database was queried for adults who underwent RPS resection. Estimated risk for outcomes was calculated twice in the risk calculator, once using sarcoma‐specific CPT codes and once using codes indicative of most comorbid organ resection (eg nephrectomy). ROC curves were generated, with area under the curve (AUC) and Brier scores reported to assess discrimination and calibration. An AUC < 0.6 was considered ineffective discrimination. A negative ▲ Brier indicated improved performance relative to baseline outcome rates.ResultsIn total, 482 patients were identified with a 42.3% 90‐day complication rate. Discrimination was poor for all outcomes except “all complications” and “renal failure.” Baseline outcome rates were better predictors than calculator estimates except for “discharge to nursing or rehab facility” and “renal failure.” Replacing sarcoma‐specific CPT codes with resection‐specific codes did not improve performance.ConclusionThe ACS‐NSQIP risk calculator poorly predicted outcomes following RPS resection. Changing sarcoma‐specific CPT to resection‐specific codes did not improve performance. Comorbidities in the calculator may not effectively capture perioperative risk. Future work should evaluate a sarcoma‐specific calculator.

Utility of the ACS‐NSQIP surgical risk calculator in predicting postoperative complications in patients undergoing oncologic proximal femoral replacement

“…In all these previous studies the authors found the risk calculator to be a poor predictor of postoperative complications 22–24 . This is likely due to the complexity of the resection and the lack of the ability to adequately capture the patient‐specific risk factors inherent to sarcoma surgery such as radiotherapy and chemotherapy, and the inability to utilize multiple CPT codes 22–24 . The results of these previous studies and the current study support the need for an oncologic specific risk‐calculator that can adequately capture known risk factors for early complications such as radiotherapy and chemotherapy, in addition to the ability to combine different CPT codes to reflect the multidisciplinary nature of these surgeries.…”

“…In addition, there have been the previous series examining the use of this calculator in the setting of a sarcoma 22–24 . In all these previous studies the authors found the risk calculator to be a poor predictor of postoperative complications 22–24 .…”

“…In addition, there have been the previous series examining the use of this calculator in the setting of a sarcoma 22–24 . In all these previous studies the authors found the risk calculator to be a poor predictor of postoperative complications 22–24 . This is likely due to the complexity of the resection and the lack of the ability to adequately capture the patient‐specific risk factors inherent to sarcoma surgery such as radiotherapy and chemotherapy, and the inability to utilize multiple CPT codes 22–24 .…”

Development and Validation of the Bone Tumor Surgery Complexity Score

“…We are continually refining the system based on feedback from its practical applications, highlighting areas where additional data could enhance its precision and reliability. This methodology not only ensures clarity and consistency in scoring but also aligns with the real-world complexity encountered in clinical practice, thereby enhancing the score's applicability and validity, as emphasized in recent studies [28,29].…”

Traditional risk scores do not properly predict perioperative morbidity and mortality for retroperitoneal sarcoma resection

“…In 2020, Schwartz et al 6 published a study to test the ability of ACS-NSQIP to predict risk for outcomes following 482 RPS procedures. They concluded that the calculator poorly predicted perioperative outcomes, and the comorbidities may not have accurately captured perioperative risk.…”