Assessment of the NSQIP Surgical Risk Calculator in Predicting Microvascular Head and Neck Reconstruction Outcomes

Abstract

Objective This study evaluated the accuracy of the Surgical Risk Calculator (SRC) of the ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program) in predicting head and neck microvascular reconstruction outcomes. Study Design Retrospective analysis. Setting Tertiary medical center. Subjects and Methods A total of 561 free flaps were included in the analysis. The SRC-predicted 30-day rates of postoperative complications, hospital length of stay (LOS), and rehabilitation discharge were compared with the actual rates and events. The SRC's predictive value was examined with Brier scores and receiver operating characteristic area under the curve. Results A total of 425 myocutaneous, 134 osseous (84 fibula, 47 scapula, and 3 iliac crest), and 2 omental free flaps were included in this study. All perioperative complications evaluated had area under the curve values ≤0.75, ranging from 0.480 to 0.728. All but 2 postoperative complications had Brier scores >0.01. SRC-predicted LOS was 9.4 ± 2.38 days (mean ± SD), which did not strongly correlate with the actual LOS of 11.98 ± 9.30 days ( r = 0.174, P < .0001). Conclusion The SRC is a poor predictor for surgical outcome among patients undergoing microvascular head and neck reconstruction.

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

“…Ma et al analyzed 561 head and neck free flaps and found that, although SRC demonstrated a Brier score <0.01 for urinary tract infection and renal complications, no complications were associated with a C statistic >0.8 indicating inadequate test performance. Furthermore, LOS was not accurately predicted by the SRC in their study …”

“…Furthermore, LOS was not accurately predicted by the SRC in their study. 11 Limitations to the NSQIP SRC calculator are well known. 19 Notably, it was developed as a universal calculator and does not factor in many aspects distinct to head and neck surgery patients such as flap loss, speech and swallowing symptoms, and tracheostomy dependence.…”

“…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.…”

Optimizing classical risk scores to predict complications in head and neck surgery: a new approach

“…Prasad et al concluded, in a cohort of 98 patients, that ACS-NSQIP risk calculator was a poor predictor of perioperative complications following major head and neck operations [28]. Other two recent studies pertaining to microvascular head and neck reconstruction showed poor prediction performance of ACS-NSQIP [29,30]. In addition, Schneider et al have added total laryngectomy to the list of complex procedures for which the NSQIP risk calculator may not be as accurate in predicting postoperative adverse events [31].…”