Usefulness of the Myocardial Infarction and Cardiac Arrest Calculator as a Discriminator of Adverse Cardiac Events After Elective Hip and Knee Surgery

Peterson, Brandon; Ghahramani, Mehrdad; Harris, Stephanie J.; Suchniak-Mussari, Kristen; Bedi, Gurneet; Bulathsinghala, Charles M.; Foy, Andrew

doi:10.1016/j.amjcard.2016.03.050

Cited by 28 publications

(17 citation statements)

References 14 publications

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“…3 clearly depicts the dissimilarity between predicted and observed LOS for the FF group and overall population, when compared to that of the NFF group. Our overall population and the FF sub-group results are consistent with many other publications, which found little to no association between observed and predicted length of stay [ 12 , 15 – 17 , 21 , 22 ]. Massoumi et al implicated the level of care offered by a hospital (primary vs. tertiary) and its practices as potential generators of these inconsistencies [ 20 ].…”

Section: Discussionsupporting

confidence: 92%

“…The risk calculator scored well for both calibrated and discrimination for 6 of 12 outcomes in the total study population. Our results demonstrating the risk calculator’s accuracy for a portion of complications predicted are consistent with that of previous publications [ 21 , 22 , 33 ]; however, they are inconsistent with other evaluations specific to the head and neck discipline. Two potential reasons for this discrepancy are differences in Brier score threshold values used and patient population heterogeneity.…”

Section: Discussionsupporting

confidence: 74%

“…Length of stay analyses were completed for the overall study population and for both NFF and FF stratifications. Analyses were completed using the Wilcoxon signed–ranked test for nonparametric data [ 12 , 22 ] and one patient was excluded from analysis due to ongoing hospital stay at time of manuscript development. Figure 3 compares the box plots of observed and predicted lengths of stay for each sub-stratification and the total study population.…”

Section: Resultsmentioning

confidence: 99%

“…Additionally, Cohen et al does not at all use, nor refer to, the Brier score test in their analysis [ 31 ]. Other published threshold values are much higher, including 0.16 [ 21 ] and 0.14 [ 22 ]. Due to these discrepancies, we decided to use 0.09, a relatively intermediate value that has been shown to indicate accuracy for models with low incidence rates [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 98%

“…For these reasons, and others, various subspecialties have evaluated the efficacy of the ACS NSQIP surgical risk calculator in practice. Results from these studies are markedly inconsistent, with conclusions for the risk calculator ranging from entirely non-predictive for all outcomes [ 9 ] to useful within judicious parameters [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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

Vosler

Orsini

Enepekides

et al. 2018

J of Otolaryngol - Head & Neck Surg

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BackgroundThe American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) universal surgical risk calculator is an online tool intended to improve the informed consent process and surgical decision-making. The risk calculator uses a database of information from 585 hospitals to predict a patient’s risk of developing specific postoperative outcomes.MethodsPatient records at a major Canadian tertiary care referral center between July 2015 and March 2017 were reviewed for surgical cases including one of six major head and neck oncologic surgeries: total thyroidectomy, total laryngectomy, hemiglossectomy, partial glossectomy, laryngopharyngectomy, and composite resection. Preoperative information for 107 patients was entered into the risk calculator and compared to observed postoperative outcomes. Statistical analysis of the risk calculator was completed for the entire study population, for stratification by procedure, and by utilization of microvascular reconstruction. Accuracy was assessed using the ratio of predicted to observed outcomes, Receiver Operating Characteristics (ROC), Brier score, and the Wilcoxon signed–ranked test.ResultsThe risk calculator accurately predicted the incidences for 11 of 12 outcomes for patients that did not undergo free flap reconstruction (NFF group), but was less accurate for patients that underwent free flap reconstruction (FF group). Length of stay (LOS) analysis showed similar results, with predicted and observed LOS statistically different in the overall population and FF group analyses (p = 0.001 for both), but not for the NFF group analysis (p = 0.764). All outcomes in the NFF group, when analyzed for calibration, met the threshold value (Brier scores < 0.09). Risk predictions for 8 of 12, and 10 of 12 outcomes were adequately calibrated in the FF group and the overall study population, respectively. Analyses by procedure were excellent, with the risk calculator showing adequate calibration for 7 of 8 procedural categories and adequate discrimination for all calculable categories (6 of 6).ConclusionThe NSQIP-RC demonstrated efficacy for predicting postoperative complications in head and neck oncology surgeries that do not require microvascular reconstruction. The predictive value of the metric can be improved by inclusion of several factors important for risk stratification in head and neck oncology.

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