Golden Daniel L, Ata Ashar, Kusupati Vinita, Jenkel Timothy, Khakoo Nidah S, Taguma Kristie, Siddiqui Ramail, Chan Ryan, Rivetz Jessica, Rosati Carl
Am Surg. 2019 Apr 1;85(4):335-341.
The ACS NSQIP Surgical Risk Calculator (SRC) is an evidence-based clinical tool commonly used for evaluating postoperative risk. The goal of this study was to validate SRC-predicted complications by comparing them with observed outcomes in the acute care surgical setting. In this study, pre- and postoperative data from 1693 acute care surgeries (hernia repair, enterolysis, intestinal incision/excision and enterectomy, gastrectomy, debridement, colectomy, appendectomy, cholecystectomy, gastrorrhaphy, and incision and drainage of soft tissue, breast abscesses, and removal of foreign bodies) performed at a Level I trauma center over a five-year time period were abstracted. Predictions for any and serious complications were based on SRC were compared with observed outcomes using various measures of diagnostic. When evaluated as one group, the SRC had good discriminative power for predicting any and serious complications after acute care surgeries (Area Under the Curve (AUC) 0.79, 0.81). In addition, the SRC met Brier score requirements for an informative model overall. However, the predictive accuracy of the SRC varied for various procedures within the acute care patient population. For serious complications, the diagnostic measures ranged from an AUC of 0.61 and negative likelihood ratio of 0.716 for incision & drainage soft tissue to AUC of 0.91 and negative likelihood ratio of 0.064 for gastrorrhaphy. Length of stay was significantly underestimated by the SRC overall (8.56 days, < 0.01) and for individual procedures. The SRC performs well at predicting complications after acute care surgeries overall; however, there is great variability in performance between procedure types. Further refinements in risk stratification may improve SRC predictions.
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（SRC）是一种基于证据的临床工具，常用于评估术后风险。本研究的目的是通过将SRC预测的并发症与急性护理手术环境中的观察结果进行比较，来验证其预测准确性。在本研究中，提取了一家一级创伤中心在五年时间内进行的1693例急性护理手术（疝修补术、肠粘连松解术、肠切开/切除术和肠切除术、胃切除术、清创术、结肠切除术、阑尾切除术、胆囊切除术、胃修补术以及软组织切开引流术、乳腺脓肿切开引流术和异物取出术）的术前和术后数据。将基于SRC对任何并发症和严重并发症的预测与使用各种诊断指标的观察结果进行比较。当作为一个整体进行评估时，SRC在预测急性护理手术后的任何并发症和严重并发症方面具有良好的鉴别能力（曲线下面积（AUC）分别为0.79和0.81）。此外，SRC总体上符合信息性模型的Brier评分要求。然而，SRC在急性护理患者群体中对不同手术的预测准确性有所不同。对于严重并发症，诊断指标的范围从软组织切开引流术AUC为0.61、阴性似然比为0.716到胃修补术AUC为0.
