Hers Tessa M, Van Schaik Jan, Keekstra Niels, Putter Hein, Hamming Jaap F, Van Der Vorst Joost R
Department of Surgery, Leiden University Medical Centre (LUMC), 2333 ZA Leiden, The Netherlands.
Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre (LUMC), 2333 ZA Leiden, The Netherlands.
J Clin Med. 2021 Nov 20;10(22):5426. doi: 10.3390/jcm10225426.
The aim of this retrospective study was to assess the predictive performance of the American College of Surgeons (ACS) risk calculator for aortic aneurysm repair for the patient population of a Dutch tertiary referral hospital.
This retrospective study included all patients who underwent elective endovascular or open aortic aneurysm repair at our institution between the years 2013 and 2019. Preoperative patient demographics and postoperative complication data were collected, and individual risk assessments were generated using five different current procedural terminology (CPT) codes. Receiver operating characteristic (ROC) curves, calibration plots, Brier scores, and Index of Prediction Accuracy (IPA) values were generated to evaluate the predictive performance of the ACS risk calculator in terms of discrimination and calibration.
Two hundred thirty-four patients who underwent elective endovascular or open aortic aneurysm repair were identified. Only five out of thirteen risk predictions were found to be sufficiently discriminative. Furthermore, the ACS risk calculator showed a structurally insufficient calibration. Most Brier scores were close to 0; however, comparison to a null model though IPA-scores showed the predictions generated by the ACS risk calculator to be inaccurate. Overall, the ACS risk calculator showed a consistent underestimation of the risk of complications.
The ACS risk calculator proved to be inaccurate within the framework of endovascular and open aortic aneurysm repair in our medical center. To minimize the effects of patient selection and cultural differences, multicenter collaboration is necessary to assess the performance of the ACS risk calculator in aortic surgery.
本回顾性研究旨在评估美国外科医师学会（ACS）主动脉瘤修复风险计算器对一家荷兰三级转诊医院患者群体的预测性能。
本回顾性研究纳入了2013年至2019年间在我院接受择期血管内或开放性主动脉瘤修复的所有患者。收集术前患者人口统计学资料和术后并发症数据，并使用五种不同的当前程序编码（CPT）生成个体风险评估。生成受试者操作特征（ROC）曲线、校准图、Brier评分和预测准确性指数（IPA）值，以评估ACS风险计算器在区分能力和校准方面的预测性能。
共确定了234例接受择期血管内或开放性主动脉瘤修复的患者。在13项风险预测中，只有5项具有足够的区分能力。此外，ACS风险计算器显示出结构上校准不足。大多数Brier评分接近0；然而，通过IPA评分与空模型比较显示，ACS风险计算器生成的预测不准确。总体而言，ACS风险计算器对并发症风险的估计持续偏低。
在我们医疗中心的血管内和开放性主动脉瘤修复框架内，ACS风险计算器被证明是不准确的。为了尽量减少患者选择和文化差异的影响，有必要开展多中心合作，以评估ACS风险计算器在主动脉手术中的性能。
