Comparison of observed to predicted outcomes using the ACS NSQIP risk calculator in patients undergoing pancreaticoduodenectomy

Abstract

Background Postoperative outcomes predicted by the ACS NSQIP universal risk calculator have not been validated for specific procedures like pancreaticoduodenectomy (PD). Methods A random sample of 400 PD patients from the NSQIP database was analyzed. Patients were categorized into four groups of 100 each based on ICD-9 diagnosis (211.6, 157.0, 156.2, and 577.1). Estimated risks of postoperative outcomes recorded by the calculator were compared to observed outcomes using the Brier Score (BS). The calculated BS was compared to a null model BS. A BS of zero indicated perfect prediction, while a BS of one indicated the poorest prediction. Results BS for all groupings was generally low, reflecting good prediction. BS for any and major complications was higher (0.23 and 0.22, respectively). This was also seen within ICD-9 subgroups. For patients with ampullary cancer, BS for these outcomes was higher (0.27 and 0.26, respectively). Comparison to the null model BS (0.24 and 0.24, respectively) correlated lesser predictive accuracy of the calculator for this subgroup. Conclusions The ACS NSQIP risk calculator, although accurate in predicting outcomes in patients undergoing PD, shows variation when accounting for specific ICD-9 diagnoses. Incorporating the diagnosis may better guide surgeons and patients preoperatively in making informed decisions.

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

“…Dahlke et al [ 9 ] reported good predictive accuracy of the ACS-NSQIP calculator in patients undergoing general and colon surgery. Similarly, Mogal et al [ 10 ] showed that the ACS-NSQIP calculator had good accuracy in predicting outcomes after pancreaticoduodenectomy, in spite of a slight variation between diagnostic groups. However, more recent studies have found limited predictive value of the ASC-NSQIP in patients undergoing other types of surgeries.…”

Implications of Prolonged Time to Pancreaticoduodenectomy After Neoadjuvant Chemoradiation

“…1 Significant improvements in diagnostic modalities, standardization in surgical techniques, and advancement in neoadjuvant and adjuvant therapies have led to a perioperative mortality rate of 2% and increased 5-y survival rates up to 27%. [2][3][4] Recent guidelines have recognized neoadjuvant chemoradiotherapy for localized pancreatic adenocarcinoma as the preferred treatment strategy with borderline resectable cancer and an acceptable treatment option for patients with potentially resectable cancer. [5][6][7][8][9] Proposed benefits of this approach include the selection of patients with favorable tumor biology, early treatment of micrometastatic disease, facilitation of a margin-negative resection, and maximal delivery of all components of multimodality therapy.…”

Modified frailty index predicts postoperative outcomes in older gastrointestinal cancer patients

“…A standardized, quantifiable measurement of frailty may inform clinicians of the patient's ability to tolerate surgical resection, and thus may improve patient outcomes. With the aim of identifying high‐risk surgical candidates, several preoperative risk prediction models have been proposed, such as the Physiological and Operative Scoring System for enumeration of Morbidity and mortality (POSSUM), Estimation of Physiologic Ability, and Surgical Stress Score (E‐PASS), NSQIP risk calculator, and comprehensive geriatric assessment (CGA) . However, these models have several disadvantages, as they are complex, time‐consuming, or inconsistent …”