Eliza W Beal1, Ezra Lyon1, Joe Kearney1, Lai Wei1, Cecilia G Ethun2, Sylvester M Black1, Mary Dillhoff1, Ahmed Salem3, Sharon M Weber3, Thuy B Tran4, George Poultsides4, Rivfka Shenoy5, Ioannis Hatzaras5, Bradley Krasnick5, Ryan C Fields6, Stefan Buttner7, Charles R Scoggins8, Robert C G Martin8, Chelsea A Isom9, Kamron Idrees9, Harveshp D Mogal10, Perry Shen10, Shishir K Maithel2, Timothy M Pawlik1, Carl R Schmidt11. 1. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH, USA. 2. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 3. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 4. Department of Surgery, Stanford University Medical Center, Stanford, USA. 5. Department of Surgery, New York University, New York, NY, USA. 6. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA. 7. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA. 8. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA. 9. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 10. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA. 11. Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH, USA. Electronic address: Carl.Schmidt@osumc.edu.
Abstract
BACKGROUND: The objective of this study is to evaluate use of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online risk calculator for estimating common outcomes after operations for gallbladder cancer and extrahepatic cholangiocarcinoma. METHODS: Subjects from the United States Extrahepatic Biliary Malignancy Consortium (USE-BMC) who underwent operation between January 1, 2000 and December 31, 2014 at 10 academic medical centers were included in this study. Calculator estimates of risk were compared to actual outcomes. RESULTS: The majority of patients underwent partial or major hepatectomy, Whipple procedures or extrahepatic bile duct resection. For the entire cohort, c-statistics for surgical site infection (0.635), reoperation (0.680) and readmission (0.565) were less than 0.7. The c-statistic for death was 0.740. For all outcomes the actual proportion of patients experiencing an event was much higher than the median predicted risk of that event. Similarly, the group of patients who experienced an outcome did have higher median predicted risk than those who did not. CONCLUSIONS: The ACS NSQIP risk calculator is easy to use but requires further modifications to more accurately estimate outcomes for some patient populations and operations for which validation studies show suboptimal performance.
BACKGROUND: The objective of this study is to evaluate use of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online risk calculator for estimating common outcomes after operations for gallbladder cancer and extrahepatic cholangiocarcinoma. METHODS: Subjects from the United States Extrahepatic Biliary Malignancy Consortium (USE-BMC) who underwent operation between January 1, 2000 and December 31, 2014 at 10 academic medical centers were included in this study. Calculator estimates of risk were compared to actual outcomes. RESULTS: The majority of patients underwent partial or major hepatectomy, Whipple procedures or extrahepatic bile duct resection. For the entire cohort, c-statistics for surgical site infection (0.635), reoperation (0.680) and readmission (0.565) were less than 0.7. The c-statistic for death was 0.740. For all outcomes the actual proportion of patients experiencing an event was much higher than the median predicted risk of that event. Similarly, the group of patients who experienced an outcome did have higher median predicted risk than those who did not. CONCLUSIONS: The ACS NSQIP risk calculator is easy to use but requires further modifications to more accurately estimate outcomes for some patient populations and operations for which validation studies show suboptimal performance.
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