Background: The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator has been endorsed to counsel patients regarding complications. The aim of this study was to assess its ability to predict outcomes after hepatectomy.Methods: Outcomes generated by the ACS-NSQIP were recorded in a consecutive cohort of patients. By using established classifications of complications, post-hepatectomy insufficiency and bile leak, the calculator was tested by the comparison of expected versus observed rates of events. The performance of the calculator was tested by using c-statistic and Brier score.Results: 950 patients who underwent hepatectomy between January 2014 and June 2019 were included. Predicted rates were significantly lower than actual rates: the mean ACS-NSQIP morbidity was 17.97% +/- 8.4 vs. actual 37.01% +/- 0.56 (P < 0.001); the mean ACS-NSQIP mortality was 0.91% +/- 1.48 vs. actual 1.76% +/- 0.11 (P < 0.001). Predicted length of stay (LOS) was significantly shorter: mean ACS-NSQIP was 5.81 +/- 1.66 days vs. actual 10.91 +/- 4.6 days (P < 0.001). Post-hepatectomy liver insufficiency and bile leak were recorded in 6.8% and 11.9% of patients, respectively. These events were not expressed by the calculator. C-statistic and Brier scores showed low performance of the calculator.Conclusion: The calculator underestimates the risks of complications, mortality and LOS after hepatectomy. Refinements of the ACS-NSQIP model that account for organ-specific risks should be considered.

Assessment of the American College of Surgeons surgical risk calculator of outcomes after hepatectomy for liver tumors: Results from a cohort of 950 patients

Donadon, Matteo;Procopio, Fabio;Torzilli, Guido
2020

Abstract

Background: The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator has been endorsed to counsel patients regarding complications. The aim of this study was to assess its ability to predict outcomes after hepatectomy.Methods: Outcomes generated by the ACS-NSQIP were recorded in a consecutive cohort of patients. By using established classifications of complications, post-hepatectomy insufficiency and bile leak, the calculator was tested by the comparison of expected versus observed rates of events. The performance of the calculator was tested by using c-statistic and Brier score.Results: 950 patients who underwent hepatectomy between January 2014 and June 2019 were included. Predicted rates were significantly lower than actual rates: the mean ACS-NSQIP morbidity was 17.97% +/- 8.4 vs. actual 37.01% +/- 0.56 (P < 0.001); the mean ACS-NSQIP mortality was 0.91% +/- 1.48 vs. actual 1.76% +/- 0.11 (P < 0.001). Predicted length of stay (LOS) was significantly shorter: mean ACS-NSQIP was 5.81 +/- 1.66 days vs. actual 10.91 +/- 4.6 days (P < 0.001). Post-hepatectomy liver insufficiency and bile leak were recorded in 6.8% and 11.9% of patients, respectively. These events were not expressed by the calculator. C-statistic and Brier scores showed low performance of the calculator.Conclusion: The calculator underestimates the risks of complications, mortality and LOS after hepatectomy. Refinements of the ACS-NSQIP model that account for organ-specific risks should be considered.
ACS-NSQIP calculator
Bile leak
Complications
Hepatectomy
Liver failure
Mortality
Adult
Aged
Aged, 80 and over
Cohort Studies
Female
Hepatectomy
Humans
Length of Stay
Liver Neoplasms
Male
Middle Aged
Postoperative Complications
Quality Improvement
Risk Assessment
Surgeons
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/62683
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