美国外科医师学会国家外科质量改进计划手术风险计算器是否适用于接受保乳手术的乳腺癌患者？
Is the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator applicable for breast cancer patients undergoing breast-conserving surgery?
作者信息
Lyle Brian, Landercasper Jeffrey, Johnson Jeanne M, Al-Hamadani Mohammed, Vang Choua A, Groshek Jacqueline, Hennessy Joy L, Theede Lonna M, Zutavern Kristin, Linebarger Jared H
机构信息
Department of Surgery, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA; Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
Department of Surgery, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA; Norma J. Vinger Center for Breast Care, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA.
出版信息
Am J Surg. 2016 Apr;211(4):820-3. doi: 10.1016/j.amjsurg.2015.07.013. Epub 2015 Sep 28.
BACKGROUND
We aimed to analyze the applicability of the National Surgical Quality Improvement Program (NSQIP) calculator to patients undergoing breast-conserving surgery.
METHODS
A total of 287 consecutive patients treated with breast-conserving surgery from 2010 to 2012 were identified retrospectively. The risk calculator was applied to each patient to generate an individual risk profile. Risk calculations were then compared with actual outcomes. The performance of the risk calculator was evaluated using 2 metrics: the Brier score and c statistic.
RESULTS
The NSQIP calculator performed adequately for all complications, with Brier scores less than .05. However, 37 patients (12.9%) returned to the operating room for oncologic indications. Twenty-nine patients (10.1%) had positive margins, whereas 8 patients (2.8%) returned due to an upgrade in diagnosis.
CONCLUSIONS
When considering return to the operating room for oncologic management, the observed rate of 13.9% is significantly higher than the NSQIP prediction. This deviation must be addressed when using the NSQIP risk calculator model during preoperative risk discussion.
背景
我们旨在分析国家外科质量改进计划（NSQIP）计算器对接受保乳手术患者的适用性。
方法
回顾性确定2010年至2012年期间连续接受保乳手术治疗的287例患者。将风险计算器应用于每位患者以生成个体风险概况。然后将风险计算结果与实际结果进行比较。使用两个指标评估风险计算器的性能：Brier评分和c统计量。
结果
NSQIP计算器对所有并发症的表现良好，Brier评分低于0.05。然而，37例患者（12.9%）因肿瘤学指征返回手术室。29例患者（10.1%）切缘阳性，而8例患者（2.8%）因诊断升级返回。
结论
在考虑因肿瘤学管理返回手术室时，观察到的13.9%的发生率显著高于NSQIP预测值。在术前风险讨论中使用NSQIP风险计算器模型时，必须解决这种偏差。
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