Is the ACS-NSQIP Risk Calculator Accurate in Predicting Adverse Postoperative Outcomes in the Emergency Setting? An Ital
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ORIGINAL SCIENTIFIC REPORT
Is the ACS-NSQIP Risk Calculator Accurate in Predicting Adverse Postoperative Outcomes in the Emergency Setting? An Italian Single-center Preliminary Study Giovanni Scotton1 • Giulio Del Zotto1 • Laura Bernardi1 • Annalisa Zucca1 Susanna Terranova1 • Stefano Fracon1 • Lucia Paiano1 • Davide Cosola1 • Alan Biloslavo1 • Nicolo` de Manzini1
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Accepted: 8 July 2020 Ó The Author(s) 2020
Abstract Background The ACS-NSQIP surgical risk calculator (SRC) is an open-access online tool that estimates the chance for adverse postoperative outcomes. The risk is estimated based on 21 patient-related variables and customized for specific surgical procedures. The purpose of this monocentric retrospective study is to validate its predictive value in an Italian emergency setting. Methods From January to December 2018, 317 patients underwent surgical procedures for acute cholecystitis (n = 103), appendicitis (n = 83), gastrointestinal perforation (n = 45), and intestinal obstruction (n = 86). Patients’ personal risk was obtained and divided by the average risk to calculate a personal risk ratio (RR). Areas under the ROC curves (AUC) and Brier score were measured to assess both the discrimination and calibration of the predictive model. Results The AUC was 0.772 (95%CI 0.722–0.817, p \ 0.0001; Brier 0.161) for serious complications, 0.887 (95%CI 0.847–0.919, p \ 0.0001; Brier 0.072) for death, and 0.887 (95%CI 0.847–0.919, p \ 0.0001; Brier 0.106) for discharge to nursing or rehab facility. Pneumonia, cardiac complications, and surgical site infection presented an AUC of 0.794 (95%CI 0.746–0.838, p \ 0.001; Brier 0.103), 0.836 (95%CI 0.790–0.875, p \ 0.0001; Brier 0.081), and 0.729 (95%CI 0.676–0.777, p \ 0.0001; Brier 0.131), respectively. A RR [ 1.24, RR [ 1.52, and RR [ 2.63 predicted the onset of serious complications (sensitivity = 60.47%, specificity = 64.07%; NPV = 81%), death (sensitivity = 82.76%, specificity = 62.85%; NPV = 97%), and discharge to nursing or rehab facility (sensitivity = 80.00%, specificity = 69.12%; NPV = 95%), respectively. Conclusions The calculator appears to be accurate in predicting adverse postoperative outcomes in our emergency setting. A RR cutoff provides a much more practical method to forecast the onset of a specific type of complication in a single patient.
Introduction
Presented at the 105th Annual Clinical Congress of the American College of Surgeons, San Francisco, 27–31 October 2019. & Giovanni Scotton [email protected] 1
Department of General Surgery, ASUGI, Cattinara Hospital, Strada di Fiume 447, 34149 Trieste TS, Italy
Acute non-traumatic abdominal pain is a common symptom in the emergency department, accounting for up to 5–6.6% of all visits [1, 2]. Similar results are consistent with data published by large Italian series, which report acute abdominal pain as the leading symptom in 5.76–9.1% of the total adult emergency department visits [3, 4]. Of hospital admissions for acute abdominal pain, biliary colic and cholecystitis account for as many as 1
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