The global prevalence of adults with diabetes is currently in excess of 415 million and is expected to increase to over 640 million by 2040. 1 Foot ulceration is common in patients with diabetes, with a 25% estimated lifetime risk of developing a foot ulcer. 2 Diabetic foot ulceration (DFU) is associated with significant morbidity, including major limb amputation and cardiovascular events, as well as mortality. 2,3 It is difficult to treat and often necessitates
Objective: The objective of this study was to assess the ability of the American College of Surgeons (ACS)
NSQIP surgical risk calculator to accurately identify patients at increased risk of perioperative complication
following surgery for gynaecological malignancy.
Methods: A retrospective review of 142 patients who underwent major surgery under the gynae-oncology
team between 06/08/2018-16/04/2019 at the University Hospital of Wales. Pre-operative factors combined
with a procedure-specific code generated the predicted risk of 13 post-operative complications for each
patient. Brier scores assessed calibration and receiver operated curves (AUC) evaluated the discriminative
power of NSQIP.
Results: Complications were experienced by 50/142 (35.2%) patients. The calculator displayed adequate
calibration when used to predict serious complications (Brier = 0.070), readmission (Brier = 0.058), return
to OR (Brier = 0.000) and UTI (Brier = 0.001). It had the greatest discriminative power when predicting the
risk of serious complications (AUC = 0.672; 95% CI, 0.481-0.863). The calculator successfully identified a
majority of patients who had a complication as being of ‘above average risk’ for all complications, apart
from return to OR, based on their pre-operative factors.
Discussion: NSQIP has previously been demonstrated to be a useful pre-operative tool for evaluating the
risk of post-operative complications in colorectal surgery. This study suggests that in the setting of gynaeoncology surgery the calculator does not have adequate discriminative power to be an absolute predictor of
all complications, however, it may be useful in identifying patients who are likely to develop serious
complications and those at above average risk of complications.
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