University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Int Urogynecol J. 2020 Oct;31(10):2089-2094. doi: 10.1007/s00192-020-04364-8. Epub 2020 Jun 16.
The purpose of this study was to evaluate the accuracy of the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) surgical risk calculator in predicting postoperative complications in patients undergoing pelvic organ prolapse surgery.
We performed a retrospective review of 354 patients who underwent surgery for pelvic organ prolapse from 2013 to 2017 at a single academic institution. Patient medical information and surgical procedure were entered into the calculator to obtain predicted complication rates, which were compared with observed complications. Logistic regression, C-statistic, and Brier score were used to assess the accuracy of the calculator.
Of 354 patients included in the analysis, 79.7% were under the age of 75, and 41.5% were classified as American Society of Anesthesiologists class ≥3. The majority of patients underwent robotic sacrocolpopexy (40.7%) or uterosacral ligament suspension (36.4%), followed by colpocleisis, abdominal sacrocolpopexy, and extraperitoneal suspension. Complications were experienced by 100 patients (28.3%). Most common complications were urinary tract infection (n = 57), surgical site infection (n = 42), and readmission (n = 16); other complications were rare. The surgical risk calculator displayed poor predictive ability for experiencing a complication (C-statistic = 0.547, Brier score = 0.25).
The NSQIP surgical risk calculator displayed poor predictive ability in our cohort of patients undergoing surgery for pelvic organ prolapse, suggesting that this tool might have limited clinical applicability to individual patients in this population.
本研究旨在评估美国外科医师学院国家手术质量改进计划（ACS NSQIP）手术风险计算器预测接受盆腔器官脱垂手术患者术后并发症的准确性。
我们对 2013 年至 2017 年在一家学术机构接受盆腔器官脱垂手术的 354 名患者进行了回顾性研究。将患者的医疗信息和手术过程输入计算器，以获得预测的并发症发生率，并将其与实际观察到的并发症进行比较。使用逻辑回归、C 统计量和 Brier 评分评估计算器的准确性。
在纳入分析的 354 名患者中，79.7%的年龄在 75 岁以下，41.5%的患者为美国麻醉医师协会（ASA）分级≥3 级。大多数患者接受了机器人骶骨阴道固定术（40.7%）或子宫骶骨韧带悬吊术（36.4%），其次是阴道封闭术、经腹骶骨阴道固定术和腹膜外悬吊术。100 名患者（28.3%）发生了并发症。最常见的并发症是尿路感染（n=57）、手术部位感染（n=42）和再入院（n=16）；其他并发症较为罕见。手术风险计算器对发生并发症的预测能力较差（C 统计量=0.547，Brier 评分=0.25）。
在接受盆腔器官脱垂手术的患者队列中，NSQIP 手术风险计算器的预测能力较差，这表明该工具在该人群中对个体患者的临床应用可能有限。
