Objectives The objective of our study was to explore the validity of ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program), a validated web-based tool based on 21 preoperative risk factors to predict 8 post-operative outcomes, in gynaeoncology for perioperative prediction of postoperative complications.
Despite the informed consent process, patients’ understanding of complications is often limited, making it difficult to call the decision informed, so estimating the risk of postoperative complications is important for shared decision making.
Methods A retrospective multicentre cohort study evaluated 1552 patients who underwent surgery. Data collection undertaken through dedicated database and notes. Data collated on 764 patients undergoing robotic, 248 laparoscopic and 540 open surgery for gynaecological malignancy. Following data lock with the actual post-op event/complication, ACS NSQIP used to count predictive scores. Data analysis evaluating ACS-NSQIP validity and relevance in gynaeoncology patients and its ability to predict postoperative complications performed.
Results ACS-NSQIP was found to best predict mortality (AUC-0.900), it was most accurate for prediction of complications as follows: discharge to rehabilitation (AUC-0.866), cardiac complications (AUC-0.844), sepsis (AUC-0.795), pneumonia (AUC-0.779), VTE (AUC-0.715), return to theatre (AUC-0.715), surgical site infection (AUC-0.684), readmission (AUC-0.680), renal failure (AUC-0.665). Poor result in the prediction of UTI (AUC-0.561) was noted.
Conclusions ACS-NSQIP risk calculator appears to predict major complications and post-operative mortality making it useful as an informed consent tool. Preliminary data suggests that further validation is required to fully evaluate if the risk scores may be used to inform patients pre-operatively of their risk of complications and is currently undertaken.
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