Use of the American College of Surgeons NSQIP Surgical Risk Calculator for Laparoscopic Colectomy: How Good Is It and How Can We Improve It?
Use of the American College of Surgeons NSQIP Surgical Risk Calculator for Laparoscopic Colectomy: How Good Is It and How Can We Improve It?
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DOI：
10.1016/j.jamcollsurg.2014.12.007
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发表时间：
2015-03-01
影响因子：
5.2
通讯作者：
Senagore, Anthony J.
中科院分区：
文献类型：
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作者：
Cologne, Kyle G.;Keller, Deborah S.;Senagore, Anthony J.
背景：美国外科医生学会 NSQIP 风险计算器是根据多机构临床数据开发的，用于估计术前风险。异常值的影响有可能极大地影响预测。尽管在大型系列中异常值的影响被最小化，但它们对个体提供者或机构的影响可能是深远的。之前没有研究评估过单个机构或提供商的风险计算器，包括异常值。我们的目标是评估单个机构预测结果的准确性。 研究设计：使用风险计算器对由三级转诊中心的两名结直肠外科医生进行的腹腔镜结肠切除术进行前瞻性评估。将预测结果与实际结果进行比较，包括住院时间 (LOS)、并发症、返回手术室和死亡。主要结果指标是实际结果与预测结果的差异。结果：纳入了 116 名患者。实际 LOS 高于预测（平均 +/- SD 4.22 +/- 5.49 天与预测 4.11 +/- 1.18 天；p = 0.0001）。四个具有多种并发症的异常值的 LOS 距离平均值>3 个标准差。去除这些后，观察到的 LOS 明显短于预测（调整后的 LOS 平均值 +/- SD 3.31 +/- 2.30 天与预测的 4.05 +/- 1.14 天；p = 0.002）。任何并发症的发生率均显着低于预测（17.3% vs 19.4%；p = 0.05）。主要并发症发生率（13.2% vs 19.4%；p = 0.009）和手术部位感染率（9.8% vs 11.8%；p = 0.006）也显着低于预测。死亡、尿路感染、肾衰竭和再手术率没有显着差异。 结论：虽然风险计算器对于评估平均手术风险患者是有效的，但它不能准确预测一小部分患者发生一种或多种严重并发症时的结果。通过美国外科医生学会病例记录系统添加外科医生和患者的特定数据可以更好地针对这些领域进行调整。 (C) 2015 年美国外科医生学会
BACKGROUND: The American College of Surgeons NSQIP risk calculator was developed from multi-institutional clinical data to estimate preoperative risk. The impact of outliers has the potential to greatly affect predictions. Although the effect of outliers is minimized in large series, their impact on the individual provider or institution could be profound. No previous study has assessed the risk calculator for a single institution or provider, including outliers. Our goal was to evaluate the accuracy of the predicted outcomes at a single institution.STUDY DESIGN: Laparoscopic colectomies performed by two colorectal surgeons at a tertiary referral center were prospectively evaluated using the risk calculator. Predicted outcomes were compared with actual outcomes for length of stay (LOS), complications, return to the operating room, and death. Main outcomes measures were differences in actual vs predicted outcomes.RESULTS: One hundred and sixteen patients were included. Actual LOS was higher than predicted (mean +/- SD 4.22 +/- 5.49 days vs predicted 4.11 +/- 1.18 days; p = 0.0001). Four outliers with multiple complications had an LOS >3 SDs from the mean. After removing these, observed LOS was significantly shorter than predicted (adjusted LOS mean +/- SD 3.31 +/- 2.30 days vs predicted 4.05 +/- 1.14 days; p = 0.002). Occurrence of any complication was significantly lower than predicted (17.3% vs 19.4%; p = 0.05). Rates of major complications (13.2% vs 19.4%; p = 0.009) and surgical site infections (9.8% vs 11.8%; p = 0.006) were also significantly lower than predicted. There were no significant differences in death, urinary tract infection, renal failure, and reoperation rates.CONCLUSIONS: Although the risk calculator was effective for evaluating average surgical-risk patients, it does not accurately predict outcomes in a small percentage of patients when one or more serious complications occur. Addition of surgeon-and patient-specific data via the American College of Surgeons case-logging system could better adjust for these areas. (C) 2015 by the American College of Surgeons