Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculator
Abstract Background The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) universal surgical risk calculator is an online tool intended to improve the informed consent process and surgical decision-making. The risk calculator uses a database of information from 5...
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| Format: | Article |
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SAGE Publishing
2018-03-01
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| Series: | Journal of Otolaryngology - Head and Neck Surgery |
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| Online Access: | http://link.springer.com/article/10.1186/s40463-018-0269-8 |
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| author | Peter S. Vosler Mario Orsini Danny J. Enepekides Kevin M. Higgins |
| author_facet | Peter S. Vosler Mario Orsini Danny J. Enepekides Kevin M. Higgins |
| author_sort | Peter S. Vosler |
| collection | DOAJ |
| description | Abstract Background The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) universal surgical risk calculator is an online tool intended to improve the informed consent process and surgical decision-making. The risk calculator uses a database of information from 585 hospitals to predict a patient’s risk of developing specific postoperative outcomes. Methods Patient records at a major Canadian tertiary care referral center between July 2015 and March 2017 were reviewed for surgical cases including one of six major head and neck oncologic surgeries: total thyroidectomy, total laryngectomy, hemiglossectomy, partial glossectomy, laryngopharyngectomy, and composite resection. Preoperative information for 107 patients was entered into the risk calculator and compared to observed postoperative outcomes. Statistical analysis of the risk calculator was completed for the entire study population, for stratification by procedure, and by utilization of microvascular reconstruction. Accuracy was assessed using the ratio of predicted to observed outcomes, Receiver Operating Characteristics (ROC), Brier score, and the Wilcoxon signed–ranked test. Results The risk calculator accurately predicted the incidences for 11 of 12 outcomes for patients that did not undergo free flap reconstruction (NFF group), but was less accurate for patients that underwent free flap reconstruction (FF group). Length of stay (LOS) analysis showed similar results, with predicted and observed LOS statistically different in the overall population and FF group analyses (p = 0.001 for both), but not for the NFF group analysis (p = 0.764). All outcomes in the NFF group, when analyzed for calibration, met the threshold value (Brier scores < 0.09). Risk predictions for 8 of 12, and 10 of 12 outcomes were adequately calibrated in the FF group and the overall study population, respectively. Analyses by procedure were excellent, with the risk calculator showing adequate calibration for 7 of 8 procedural categories and adequate discrimination for all calculable categories (6 of 6). Conclusion The NSQIP-RC demonstrated efficacy for predicting postoperative complications in head and neck oncology surgeries that do not require microvascular reconstruction. The predictive value of the metric can be improved by inclusion of several factors important for risk stratification in head and neck oncology. |
| format | Article |
| id | doaj-art-ac74cf839282483fbb03872b74bc86cb |
| institution | Kabale University |
| issn | 1916-0216 |
| language | English |
| publishDate | 2018-03-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Otolaryngology - Head and Neck Surgery |
| spelling | doaj-art-ac74cf839282483fbb03872b74bc86cb2025-02-03T00:22:58ZengSAGE PublishingJournal of Otolaryngology - Head and Neck Surgery1916-02162018-03-0147111010.1186/s40463-018-0269-8Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculatorPeter S. Vosler0Mario Orsini1Danny J. Enepekides2Kevin M. Higgins3Department of Otolaryngology—Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of TorontoDepartment of Otolaryngology—Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of TorontoDepartment of Otolaryngology—Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of TorontoDepartment of Otolaryngology—Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of TorontoAbstract Background The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) universal surgical risk calculator is an online tool intended to improve the informed consent process and surgical decision-making. The risk calculator uses a database of information from 585 hospitals to predict a patient’s risk of developing specific postoperative outcomes. Methods Patient records at a major Canadian tertiary care referral center between July 2015 and March 2017 were reviewed for surgical cases including one of six major head and neck oncologic surgeries: total thyroidectomy, total laryngectomy, hemiglossectomy, partial glossectomy, laryngopharyngectomy, and composite resection. Preoperative information for 107 patients was entered into the risk calculator and compared to observed postoperative outcomes. Statistical analysis of the risk calculator was completed for the entire study population, for stratification by procedure, and by utilization of microvascular reconstruction. Accuracy was assessed using the ratio of predicted to observed outcomes, Receiver Operating Characteristics (ROC), Brier score, and the Wilcoxon signed–ranked test. Results The risk calculator accurately predicted the incidences for 11 of 12 outcomes for patients that did not undergo free flap reconstruction (NFF group), but was less accurate for patients that underwent free flap reconstruction (FF group). Length of stay (LOS) analysis showed similar results, with predicted and observed LOS statistically different in the overall population and FF group analyses (p = 0.001 for both), but not for the NFF group analysis (p = 0.764). All outcomes in the NFF group, when analyzed for calibration, met the threshold value (Brier scores < 0.09). Risk predictions for 8 of 12, and 10 of 12 outcomes were adequately calibrated in the FF group and the overall study population, respectively. Analyses by procedure were excellent, with the risk calculator showing adequate calibration for 7 of 8 procedural categories and adequate discrimination for all calculable categories (6 of 6). Conclusion The NSQIP-RC demonstrated efficacy for predicting postoperative complications in head and neck oncology surgeries that do not require microvascular reconstruction. The predictive value of the metric can be improved by inclusion of several factors important for risk stratification in head and neck oncology.http://link.springer.com/article/10.1186/s40463-018-0269-8National surgical quality improvement program risk calculatorRisk assessmentHead and neckCancerBrier scoreSurgical complications |
| spellingShingle | Peter S. Vosler Mario Orsini Danny J. Enepekides Kevin M. Higgins Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculator Journal of Otolaryngology - Head and Neck Surgery National surgical quality improvement program risk calculator Risk assessment Head and neck Cancer Brier score Surgical complications |
| title | Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculator |
| title_full | Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculator |
| title_fullStr | Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculator |
| title_full_unstemmed | Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculator |
| title_short | Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculator |
| title_sort | predicting complications of major head and neck oncological surgery an evaluation of the acs nsqip surgical risk calculator |
| topic | National surgical quality improvement program risk calculator Risk assessment Head and neck Cancer Brier score Surgical complications |
| url | http://link.springer.com/article/10.1186/s40463-018-0269-8 |
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