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abstract
Highlights
- •
- The NSQIP calculator adequately predicted death, cardiovascular and renal complications.
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- The NSQIP calculator did not accurately predict common complications.
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- The NSQIP calculator tended to under-estimate hospital stay by one day.
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 1094 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), renal failure
(c-statistic = 0.752, Brier = 0.015) 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.
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