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Predictive validity of American College of Surgeons: National Surgical Quality Improvement Project risk calculator in patients with ovarian cancer undergoing interval debulking surgery
  1. Beryl Manning-Geist1,2,
  2. Ann M Cathcart3,
  3. Mackenzie W Sullivan1,2,
  4. Andrea Pelletier1,
  5. Stephanie Cham4,
  6. Michael G Muto1,5,
  7. Marcela Del Carmen2,
  8. Whitfield B Growdon2,
  9. Rachel Clark Sisodia2,
  10. Ross Berkowitz1,5 and
  11. Michael Worley Jr1,5
  1. 1Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Harvard Medical School, Boston, Massachusetts, USA
  4. 4Division of Gynecologic Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5Dana-Farber Cancer Institute, Boston, Massachusetts, USA
  1. Correspondence to Dr Beryl Manning-Geist, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, USA; ManningB{at}


Introduction In gynecologic patients, few studies describe the accuracy of the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) pre-operative risk calculator for women undergoing surgery for ovarian cancer.

Objective To determine whether the ACS-NSQIP risk calculator accurately predicts post-operative complications and length of stay in patients undergoing interval debulking surgery for advanced stage epithelial ovarian cancer.

Methods For this multi-institutional retrospective cohort study, pre-operative risk factors, post-operative complication rates, and Current Procedural Terminology codes were abstracted from records of patients with ovarian cancer managed with open interval debulking surgery from January 2010 to July 2015. A power calculation was done to estimate the minimum number of complications needed to evaluate the accuracy of the ACS-NSQIP risk calculator. Predicted risk compared with observed risk was calculated using logistic regression. The predictive accuracy of the ACS-NSQIP risk calculator in estimating post-operative complications or length of stay was assessed using c-statistics and Briar scores. Complications with a c-statistic of >0.70 and Brier score of <0.01 were considered to have high discriminative ability.

Results A total of 261 patients underwent interval debulking surgery, encompassing 21 unique Current Procedural Terminology codes. Readmission (n=25), surgical site infection (n=35), urinary tract infection (n=12), and serious post-operative complications (n=57) met the minimum event threshold (n>10). All predicted complication rates fell within the IQR of the observed incidence rates. However, the ACS-NSQIP calculator demonstrated neither discriminative ability nor accuracy for any post-operative complications based on c-statistics and Brier scores. The calculator accurately predicted length of stay within 1 day for only 32% of patients and could not accurately predict which patients were likely to have a prolonged length of stay (c-statistic=0.65).

Conclusion Among patients undergoing interval debulking surgery, the ACS-NSQIP did not accurately discriminate which patients were at increased risk of complications or extended length of stay. The risk calculator should be considered to have limited utility in informing pre-operative counseling or surgical planning.

  • gynecologic surgical procedures
  • surgical procedures
  • operative
  • cytoreduction surgical procedures
  • postoperative period
  • postoperative care

Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Data are available from the corresponding author upon reasonable request.

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  • Contributors Conceptualization: BM-G; data curation: BM-G, AMC; formal analysis: AP, AMC, BM-G; methodology: BM-G, AP, MW; roles/writing original draft: BM-G, AMC, MWS; writing – review and editing: all authors.

  • Funding This research was supported in part by award Number T32GM007753 from the National Institute of General Medical Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of General Medical Sciences or the National Institutes of Health.

  • Competing interests MW Jr.: CONMED Corporation (consulting and honoraria).

  • Provenance and peer review Not commissioned; externally peer reviewed.