Slump. J. (2015) Validating the ACS-NSQIP® Surgical Risk Calculator in patients undergoing flap reconstruction following sarcoma resection. thesis, Medicine.
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Abstract
Introduction The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) developed a universal surgical risk calculator, which is an online and freely accessible tool to predict the chance of developing postoperative complications, by taking into account the proposed surgical procedure and 21 patient characteristics. This study investigates the efficacy of the ACS NSQIP calculator to predict the chance of developing post-operative complications in patients undergoing flap reconstruction following sarcoma resection. Research design and methods Details of all patients requiring flap reconstruction following sarcoma resection over the past 10 years at one major cancer center were identified from a pre-existing institutional database, completed by retrospective chart review. All patients were entered into the online risk calculator. Postoperative complications obtained from the patient charts where listed and compared to the outcomes of the predicted rates obtained by entering the patient factors into the risk calculator. The calculator was validated using three statistical measures described in the original development of the ACS NSQIP surgical risk calculator. Results 265 patients with a mean age of 59 years (SD:± 18.5) could be included in our study. 84 (31.7 percent) of these underwent a free flap reconstruction and 181 (68.3 percent) patients needed a pedicled flap reconstruction. The calculator predicted that complications would occur in 15.3 percent of the patients, while actual complication rate obtained from chart review was 32.45 percent. The Hosmer-Lemeshow test shows a significant difference between the predicted rate of complications and the actual observed rate of complications (p= 2.4 E-12), indicating that the calculator is not accurately predicting the postoperative complication rate in the selected patient group. The area under the curve or c-statistic (measure of discrimination) was found to be low at 62.6 percent, suggesting that the model has random performance in this patient population. The Brier score was found to be higher than reported in the original ACS NSQIP calculator model development (0.242 Spiegelhalter’s p-value = 4.4E-15), demonstrating poor correlation between predicted probability and actual probability. These scores indicate that the calculator cannot effectively discriminate between patients who are at risk of complications and those who are not. Conclusion The present data demonstrates that the ACS NSQIP universal risk calculator does not maintain its predictive value in patients undergoing flap reconstruction following sarcoma resection, illustrating the importance of validation of universal calculators for individual patient populations.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Leij, Prof. dr. B. van der University Medical Center Gronin |
| Supervisor name: | Daily supervisor: and Hofer, Dr. S.O.P. ( M.D. and Neill Dr. A. O’ (M.D., Ph.D.) |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:02 |
| Last Modified: | 25 Jun 2020 11:02 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2229 |
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