Assessing the predictive accuracy of the American College of Surgeons National Surgical Quality Improvement Project Surgical Risk Calculator in open ventral hernia repair
Assessing the predictive accuracy of the American College of Surgeons National Surgical Quality Improvement Project Surgical Risk Calculator in open ventral hernia repair
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DOI：
10.1016/j.amjsurg.2016.01.034
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发表时间：
2016-08-01
影响因子：
3
通讯作者：
Fischer, John P.
中科院分区：
文献类型：
--
作者：
Basta, Marten N.;Bauder, Andrew R.;Fischer, John P.
背景：术前手术风险评估仍然是临床决策的关键组成部分。ACS通用风险计算器根据个人风险状况估计几种结果的风险。虽然这代表着朝着改善结果迈出了巨大的一步，但研究报告了某些患者人群的不准确性。本研究旨在评估美国外科医师学会（ACS）风险计算器在接受开放式腹疝修补术（VHR）的患者中的预测准确性。方法：对2007年7月1日至2014年7月1日期间由一名外科医生进行开放式孤立VHR的患者进行回顾。风险因素和结局按照国家手术质量改进项目的定义进行收集。30天结局包括严重并发症、静脉血栓栓塞、医疗发病率、手术部位感染（SSI）、计划外再次手术、死亡率和住院时间（LOS）。将患者资料输入ACS手术风险计算器，并记录结局特异性风险预测。使用Brier评分和受试者-操作者曲线下面积（AUC）评估预测准确性。ACS预测心脏并发症（Brier = 5.02）、静脉血栓栓塞（Brier = 0.08）、再次手术（Brier = 0.10）和死亡率（Brier = 0.01）准确。显著低估的结局包括SSI（Brier = .14）、严重并发症（Brier = .30）和任何并发症（Brier = .34）。区分的范围从高度准确（死亡率，AUC = 0.99）到不加区分（SSI，AUC = 0.57）。预测的LOS比观察到的短3倍（2.4 vs 7.4天，P
BACKGROUND: Preoperative surgical risk assessment continues to be a critical component of clinical decision-making. The ACS Universal Risk Calculator estimates risk for several outcomes based on individual risk profiles. Although this represents a tremendous step toward improving outcomes, studies have reported inaccuracies among certain patient populations. This study aimed to assess the predictive accuracy of the American College of Surgeons' (ACS) Risk Calculator in patients undergoing open ventral hernia repair (VHR).METHODS: A review of patients undergoing open, isolated VHR between 7/1/2007 and 7/1/2014 by a single surgeon was performed. Risk factors and outcomes were collected as defined by National Surgical Quality Improvement Project. Thirty-day outcomes included serious complication, venous thromboembolism, medical morbidity, surgical site infection (SSI), unplanned reoperation, mortality, and length of stay (LOS). Patient profiles were entered into the ACS Surgical Risk Calculator and outcome-specific risk predictions recorded. Prediction accuracy was assessed using the Brier score and receiver-operator area under the curve (AUC).RESULTS: One hundred forty-two patients undergoing open VHR were included. ACS predictions were accurate for cardiac complications (Brier 5.02), venous thromboembolism (Brier = .08), reoperation (Brier = .10), and mortality (Brier =.01). Significantly, underestimated outcomes included SSI (Brier = .14), serious complication (Brier = .30), and any complication (Brier = .34). Discrimination ranged from highly accurate (mortality, AUC = .99) to indiscriminate (SSI, AUC = .57). Predicted LOS was 3-fold shorter than observed (2.4 vs 7.4 days, P