NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction

Riley, Charles A.; Barton, Blair; Lawlor, Claire M.; Cai, David Z.; Riley, Phoebe E.; McCoul, Edward D.; Hasney, Christian P.; Moore, Brian A.

doi:10.1177/2473974x16685692

Cited by 9 publications

(16 citation statements)

References 29 publications

(68 reference statements)

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“…With these complications, they require more complex care and thus pose an increased burden on the health care system. These patients consume more hospital and physician resources than patients who undergo other otolaryngological surgeries . Several studies have shown differences in HNC patient outcomes based on hospital characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…These patients consume more hospital and physician resources than patients who undergo other otolaryngological surgeries. 35 Several studies have shown differences in HNC patient outcomes based on hospital characteristics. Eskander et al 36 concluded that a volume-outcome relation exists for HNCs, with high-volume hospitals having better overall survival than low-volume hospitals.…”

Section: Discussionmentioning

confidence: 99%

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Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns

Gupta

Sonis

Schneider

et al. 2017

Cancer

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Uninsured patients or patients insured by government programs predominantly underwent care for HNC at hospital types most often associated with inferior survival outcomes. This finding could explain some proportion of insurance-related disparities in HNC outcomes. Further studies are warranted to determine whether interventions to promote equitable access to optimal hospital settings for patients, regardless of their insurance type, might improve outcomes among nonprivate insurance holders. Cancer 2018;124:760-8. © 2017 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns

Gupta

Sonis

Schneider

et al. 2017

Cancer

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“…15 Additionally, Riley et al showed that the SRC was an inadequate predictor of LOS in patients undergoing any head and neck free flap surgery. 18 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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Background Predictive models to forecast the likelihood of specific outcomes after surgical intervention allow informed shared decision‐making by surgeons and patients. Previous studies have suggested that existing general surgical risk calculators poorly forecast head and neck surgical outcomes. However, no large study has addressed this question while subdividing subjects by surgery performed. Objectives To determine the accuracy of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator in estimating length of hospital stay and risk of postoperative complications after free tissue transfer surgery. Study Design A retrospective chart review of patients at one institution was performed using Current Procedural Terminology codes for anterolateral thigh (ALT) flap, fibula free flap (FFF), and radial forearm free flap (RFFF) reconstruction. Output data from the ACS NSQIP surgical risk calculator were compared with the observed rates in our patients. Methods Incidences of cardiac complications, pneumonia, venous thromboembolism, return to the operating room, and discharge to skilled nursing facility (SNF) were compared to predicted incidences. Length of stay was also compared to the predicted length of stay. Results Three hundred thirty‐six free flap reconstructions with 197 ALT flaps, 85 RFFFs, and 54 FFFFs were included. Brier scores were calculated using ACS NSQIP forecast and actual incidences. No Brier score was <0.01 for the entire sample or any subgroup, which indicates that the NSQIP risk calculator does not accurately forecast outcomes after free tissue reconstruction. Conclusion The ACS NSQIP failed to accurately forecast postoperative outcomes after head and neck free flap reconstruction for the entire sample or subgroup analyses. Level of Evidence 4 Laryngoscope, 130:679–684, 2020

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“…Although not formally in the current study, length of hospital stay has also been significantly underpredicted in numerous recent studies. [23][24][25] All of the 30-day outcomes evaluated here have been highly studied and offer significance in numerous ways. Venous thromboembolism and cardiopulmonary complications put patients at risk for sudden decompensation and death.…”

Section: Surgical Risk Calculator Predictive Accuracymentioning

confidence: 99%

Evaluating the Inaccuracy of the National Surgical Quality Improvement Project Surgical Risk Calculator in Plastic Surgery: A Meta-analysis of Short-Term Predicted Complications

et al. 2022

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Background Preoperative surgical risk assessment is a major component of clinical decision making. The ability to provide accurate, individualized risk estimates has become critical because of growing emphasis on quality metrics benchmarks. The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) Surgical Risk Calculator (SRC) was designed to quantify patient-specific risk across various surgeries. Its applicability to plastic surgery is unclear, however, with multiple studies reporting inaccuracies among certain patient populations. This study uses meta-analysis to evaluate the NSQIP SRC’s ability to predict complications among patients having plastic surgery. Methods OVID MEDLINE and PubMed were searched for all studies evaluating the predictive accuracy of the NSQIP SRC in plastic surgery, including oncologic reconstruction, ventral hernia repair, and body contouring. Only studies directly comparing SCR predicted to observed complication rates were included. The primary measure of SRC prediction accuracy, area under the curve (AUC), was assessed for each complication via DerSimonian and Laird random-effects analytic model. The I 2 statistic, indicating heterogeneity, was judged low (I 2 < 50%) or borderline/unacceptably high (I 2 > 50%). All analyses were conducted in StataSE 16.1 (StataCorp LP, College Station, Tex). Results Ten of the 296 studies screened met criteria for inclusion (2416 patients). Studies were classified as follows: (head and neck: n = 5, breast: n = 1, extremity: n = 1), open ventral hernia repair (n = 2), and panniculectomy (n = 1). Predictive accuracy was poor for medical and surgical complications (medical: pulmonary AUC = 0.67 [0.48–0.87], cardiac AUC = 0.66 [0.20–0.99], venous thromboembolism AUC = 0.55 [0.47–0.63]), (surgical: surgical site infection AUC = 0.55 [0.46–0.63], reoperation AUC = 0.54 [0.49–0.58], serious complication AUC = 0.58 [0.43–0.73], and any complication AUC = 0.60 [0.57–0.64]). Although mortality was accurately predicted in 2 studies (AUC = 0.87 [0.54–0.99]), heterogeneity was high with I 2 = 68%. Otherwise, heterogeneity was minimal (I 2 = 0%) or acceptably low (I 2 < 50%) for all other outcomes. Conclusions The NSQIP Universal SRC, aimed at offering individualized quantifiable risk estimates for surgical complications, consistently demonstrated poor risk discrimination in this plastic surgery–focused meta-analysis. The limitations of the SRC are perhaps most pronounced where complex, multidisciplinary reconstructions are needed. Future efforts should identify targets for improving SRC reliability to better counsel patients in the perioperative setting and guide appropriate healthcare resource allocation.

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NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction

Cited by 9 publications

References 29 publications

Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns

Impact of the insurance type of head and neck cancer patients on their hospitalization utilization patterns

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

Evaluating the Inaccuracy of the National Surgical Quality Improvement Project Surgical Risk Calculator in Plastic Surgery: A Meta-analysis of Short-Term Predicted Complications

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