在美国外科医师学会国家外科质量改进计划（ACS-NSQIP）中，急诊病例与择期病例的风险预测准确性存在差异。
Risk Prediction Accuracy Differs for Emergency Versus Elective Cases in the ACS-NSQIP.
作者信息
Hyder Joseph A, Reznor Gally, Wakeam Elliot, Nguyen Louis L, Lipsitz Stuart R, Havens Joaquim M
机构信息
*Department of Anesthesiology and Division of Respiratory and Critical Care Medicine, Mayo Clinic, Rochester, MN†Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN‡Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA§Department of Surgery, University of Toronto, Toronto, Ontario, Canada¶Department of Medicine, Brigham and Women's Hospital, Boston, MA||Department of Surgery, Brigham and Women's Hospital, Boston, MA**Harvard Medical School, Boston, MA.
出版信息
Ann Surg. 2016 Dec;264(6):959-965. doi: 10.1097/SLA.0000000000001558.
BACKGROUND
Accurate risk estimation is essential when benchmarking surgical outcomes for reimbursement and engaging in shared decision-making. The greater complexity of emergency surgery patients may bias outcome comparisons between elective and emergency cases.
OBJECTIVE
To test whether an established risk modelling tool, the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) predicts mortality comparably for emergency and elective cases.
METHODS
From the ACS-NSQIP 2011-2012 patient user files, we selected core emergency surgical cases also common to elective scenarios (gastrointestinal, vascular, and hepato-biliary-pancreatic). After matching strategy for Common Procedure Terminology (CPT) and year, we compared the accuracy of ACS-NSQIP predicted mortality probabilities using the observed-to-expected ratio (O:E), c-statistic, and Brier score.
RESULTS
In all, 56,942 emergency and 136,311 elective patients were identified as having a common CPT and year. Using a 1:1 matched sample of 37,154 emergency and elective patients, the O:E ratios generated by ACS-NSQIP models differ significantly between the emergency [O:E = 1.031; 95% confidence interval (CI) = 1.028-1.033] and elective populations (O:E = 0.79; 95% CI = 0.77-0.80, P < 0.0001) and the c-statistics differed significantly (emergency c-statistic = 0.927; 95% CI = 0.921-0.932 and elective c-statistic = 0.887; 95% CI = 0.861-0.912, P = 0.003). The Brier score, tested across a range of mortality rates, did not differ significantly for samples with mortality rates of 6.5% and 9% (eg, emergency Brier score = 0.058; 95% CI = 0.048-0.069 versus elective Brier score = 0.057; 95% CI = 0.044-0.07, P = 0.87, among 2217 patients with 6.5% mortality). When the mortality rate was low (1.7%), Brier scores differed significantly (emergency 0.034; 95% CI = 0.027-0.041 versus elective 0.016; 95% CI = 0.009-0.023, P value for difference 0.0005).
CONCLUSION
ACS-NSQIP risk estimates used for benchmarking and shared decision-making appear to differ between emergency and elective populations.
背景
在为手术结果设定基准以进行报销以及参与共同决策时，准确的风险评估至关重要。急诊手术患者的复杂性更高，这可能会使择期手术和急诊手术病例之间的结果比较产生偏差。
目的
测试一种既定的风险建模工具，即美国外科医师学会国家外科质量改进计划（ACS-NSQIP）对急诊和择期病例的死亡率预测是否具有可比性。
方法
从ACS-NSQIP 2011 - 2012患者用户文件中，我们选择了在择期手术中也常见的核心急诊手术病例（胃肠道、血管和肝胆胰手术）。在对通用程序术语（CPT）和年份进行匹配策略后，我们使用观察与预期比率（O:E）、c统计量和Brier评分比较了ACS-NSQIP预测死亡率概率的准确性。
结果
总共确定了56,942例急诊患者和136,311例择期患者具有相同的CPT和年份。使用37,154例急诊和择期患者的1:1匹配样本，ACS-NSQIP模型生成的O:E比率在急诊人群[O:E = 1.031；95%置信区间（CI）= 1.028 - 1.033]和择期人群（O:E = 0.79；95% CI = 0.77 - 0.80，P < 0.0001）之间存在显著差异，并且c统计量也存在显著差异（急诊c统计量 = 0.927；95% CI = 0.921 - 0.932，择期c统计量 = 0.887；95% CI = 0.861 - 0.912，P = 0.003）。在一系列死亡率范围内进行测试的Brier评分，对于死亡率为6.5%和9%的样本没有显著差异（例如，在2217例死亡率为6.5%的患者中，急诊Brier评分为0.058；95% CI = 0.048 - 0.069，而择期Brier评分为0.057；95% CI = 0.044 - 0.07，P = 0.87）。当死亡率较低（1.7%）时，Brier评分存在显著差异（急诊为0.034；95% CI = 0.027 - 0.041，而择期为0.016；95% CI = 0.009 - 0.023，差异的P值为0.0005）。
结论
用于设定基准和共同决策的ACS-NSQIP风险估计在急诊和择期人群之间似乎存在差异。
Zotero 插件