Ability of the National Surgical Quality Improvement Program Risk Calculator to Predict Complications Following Total Laryngectomy

Abstract

IMPORTANCEThe accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature.OBJECTIVE To evaluate the accuracy of the calculator's predictions in a single institution's total laryngectomy (TL) population. DESIGN, SETTING, AND PARTICIPANTSTotal laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism. MAIN OUTCOMES AND MEASURESComparison of the NSQIP risk calculator's predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis. RESULTSOf 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67% male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165%, but underestimated surgical site infection by 7%, return to operating room by 24%, and length of stay by 13%. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications.CONCLUSIONS AND RELEVANCE The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient's risk.

Predictive validity of the ACS-NSQIP surgical risk calculator in geriatric patients undergoing lumbar surgery

“…[ 11 ] Szender et al [ 7 ] reported limitations of the ACS-NSQIP in evaluating complications in patients in gynecologic oncology. Moreover, the ACS-NSQIP model did not have utility in predicting complications of knee and hip arthroplasties, [ 12 ] total laryngectomy, [ 13 ] and soft-tissue sarcoma resection. [ 14 ] These data, together with our results, suggest the limited value of the ACS-NSQIP risk calculator across patients undergoing different surgeries.…”

Predicting complications of major head and neck oncological surgery: an evaluation of the ACS NSQIP surgical risk calculator

“…in conjunction with a surgery-specific Current Procedure Terminology (CPT) code, to predict patients’ risk of 12 postoperative outcomes within 30 days after surgery [ 12 , 13 ]. Patient-specific variables chosen for the risk calculator are broadly applicable for patients undergoing one of the 1887 procedures covered [ 11 , 13 , 14 ].…”

“…Recently, this system has been evaluated in several surgical subspecialties including head and neck surgery [ 8 , 15 – 17 ], urology [ 9 ], neurology [ 10 ], pulmonology [ 18 ], gynecology [ 19 ], gastroenterology [ 12 , 20 – 23 ], orthopedics [ 24 ] and general surgery with variable results. Despite these numerous publications, very few studies have examined the risk calculator’s efficacy in a Canadian setting [ 13 , 14 ] and none, so far, have evaluated head and neck surgery in a Canadian setting. We aim to provide the first comprehensive evaluation of the risk calculator for head and neck surgery in a Canadian setting by assessing its accuracy in predicting complications following six major head and neck procedures.…”

Predictive value of the ACS NSQIP calculator for head and neck reconstruction free tissue transfer

“…The accuracy of the ACS NSQIP SRC has been evaluated in subspecialties with promising results . Few studies have focused on application of this system to head and neck surgery; in general, these studies concluded that the SRC was not a useful tool in predicting postoperative complications in patients undergoing complex head and neck surgeries . However, these studies focus on a widely heterogeneous group of procedures within the scope of head and neck surgery, making it difficult to come to a conclusion about specific procedures.…”

“…9 Few studies have focused on application of this system to head and neck surgery; in general, these studies concluded that the SRC was not a useful tool in predicting postoperative complications in patients undergoing complex head and neck surgeries. [10][11][12][13] However, these studies focus on a widely heterogeneous group of procedures within the scope of head and neck surgery, making it difficult to come to a conclusion about specific procedures. The purpose of our study is to assess the validity of the ACS NSQIP surgical risk calculator in predicting postoperative complications in patients undergoing microvascular head and neck reconstruction.…”