Yap Ma Krizia Camille, Ang Kevin Francis, Gonzales-Porciuncula Lea Arceli, Esposo Evelyn
Department of Medicine, St Luke's Medical Center, Quezon City, Philippines.
Dr. HB Calleja Heart and Vascular Institute, St Luke's Medical Center, Quezon City, Philippines.
Heart Asia. 2018 May 17;10(2):e010993. doi: 10.1136/heartasia-2017-010993. eCollection 2018.
Various risk prediction models are available to stratify patients before non-cardiac surgery and pave the way for anticipative and preventive measures. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator is an extensive tool that predicts the risk for major adverse cardiovascular events (MACE) and other perioperative outcomes. This study validated the calculator in a Filipino population and compared its predictive ability with the more widely used Revised Cardiac Risk Index (RCRI).
The study included 424 patients referred for preoperative stratification before non-cardiac surgery in St Luke's Medical Center Quezon City. The development of all-cause mortality, morbidity, pneumonia, cardiac events, venous thromboembolism, urinary tract infection, renal failure and return to operating room were observed. The discriminative ability of the ACS NSQIP to predict these outcomes was evaluated using the area under the receiver operating characteristic curve (AUC) while calibration was measured using the Brier score. The AUC of the ACS NSQIP was compared with that of the RCRI.
The ACS NSQIP Surgical Risk Calculator had excellent predictive ability for MACE and was comparable with the RCRI (AUC 0.93 vs 0.93). It also had acceptable predictive ability for pneumonia (AUC 0.93), all-cause mortality (AUC 0.89) and morbidity (AUC 0.88). It had poor to fair predictive ability for renal failure, return to operating room, surgical site infection, urinary tract infection and venous thromboembolism. Calibration was excellent for all-cause mortality, morbidity, pneumonia, venous thromboembolism and renal failure.
The ACS NSQIP Surgical Risk Calculator is a valid tool for predicting MACE and other important perioperative outcomes among Filipinos.
有多种风险预测模型可用于在非心脏手术前对患者进行分层，并为采取前瞻性和预防性措施铺平道路。美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）手术风险计算器是一种广泛使用的工具，可预测主要不良心血管事件（MACE）及其他围手术期结局的风险。本研究在菲律宾人群中验证了该计算器，并将其预测能力与使用更广泛的修订心脏风险指数（RCRI）进行比较。
该研究纳入了424名在奎松市圣卢克医疗中心接受非心脏手术术前分层评估的患者。观察全因死亡率、发病率、肺炎、心脏事件、静脉血栓栓塞、尿路感染、肾衰竭及返回手术室等情况。使用受试者操作特征曲线下面积（AUC）评估ACS NSQIP预测这些结局的判别能力，同时使用Brier评分测量校准情况。将ACS NSQIP的AUC与RCRI的AUC进行比较。
ACS NSQIP手术风险计算器对MACE具有出色的预测能力，与RCRI相当（AUC分别为0.93和0.93）。其对肺炎（AUC 0.93）、全因死亡率（AUC 0.89）和发病率（AUC 0.88）也具有可接受的预测能力。对肾衰竭、返回手术室、手术部位感染、尿路感染和静脉血栓栓塞的预测能力较差至中等。全因死亡率、发病率、肺炎、静脉血栓栓塞和肾衰竭的校准情况良好。
ACS NSQIP手术风险计算器是预测菲律宾人MACE及其他重要围手术期结局的有效工具。
