Evaluation of the ACS NSQIP surgical risk calculator in patients undergoing pelvic organ prolapse surgery
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ORIGINAL ARTICLE
Evaluation of the ACS NSQIP surgical risk calculator in patients undergoing pelvic organ prolapse surgery Susan D. Wherley 1 & Graham C. Chapman 1 & Sangeeta T. Mahajan 1 & Adonis K. Hijaz 1 & Emily A. Slopnick 1 & Kasey Roberts 1 & Sherif El-Nashar 1 Received: 3 February 2020 / Accepted: 22 May 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis The purpose of this study was to evaluate the accuracy of the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) surgical risk calculator in predicting postoperative complications in patients undergoing pelvic organ prolapse surgery. Methods We performed a retrospective review of 354 patients who underwent surgery for pelvic organ prolapse from 2013 to 2017 at a single academic institution. Patient medical information and surgical procedure were entered into the calculator to obtain predicted complication rates, which were compared with observed complications. Logistic regression, C-statistic, and Brier score were used to assess the accuracy of the calculator. Results Of 354 patients included in the analysis, 79.7% were under the age of 75, and 41.5% were classified as American Society of Anesthesiologists class ≥3. The majority of patients underwent robotic sacrocolpopexy (40.7%) or uterosacral ligament suspension (36.4%), followed by colpocleisis, abdominal sacrocolpopexy, and extraperitoneal suspension. Complications were experienced by 100 patients (28.3%). Most common complications were urinary tract infection (n = 57), surgical site infection (n = 42), and readmission (n = 16); other complications were rare. The surgical risk calculator displayed poor predictive ability for experiencing a complication (C-statistic = 0.547, Brier score = 0.25). Conclusions The NSQIP surgical risk calculator displayed poor predictive ability in our cohort of patients undergoing surgery for pelvic organ prolapse, suggesting that this tool might have limited clinical applicability to individual patients in this population. Keywords Complication . NSQIP . Postoperative . Prolapse
Introduction Pelvic organ prolapse affects at least 13% of women, with over 300,000 surgeries performed in the USA annually [1]. The population is simultaneously becoming older and sicker; the population over age 80 is anticipated to increase by 3.5fold by 2050 and nearly 40% of Americans currently qualify as obese [2, 3]. As comorbidities associated with aging and obesity become more prevalent, a firm understanding of their
Presented at AUGS/IUGA 2019, Nashville, Tennessee, USA, 25 September 2019 * Susan D. Wherley [email protected] 1
University Hospitals Cleveland Medical Center, Cleveland, OH, USA
impact on the perioperative safety of elective surgery for pelvic organ prolapse will become increasingly important. A wide range of postoperative complication rates is reported in the existing literature, ranging from 11 to 31% of patients undergoing prolapse repair [4, 5]. Given that complications occur
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