Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Kocamustafapaşa St No:53, Fatih, 34098, Istanbul, Turkey.
Department of Public Health, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Kocamustafapaşa St No: 53, Fatih, 34098, Istanbul, Turkey.
Langenbecks Arch Surg. 2023 Dec 18;409(1):12. doi: 10.1007/s00423-023-03207-6.
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is a risk stratification tool to help predict risks of postoperative complications, which is important for informed decision-making. The purpose of this study was to evaluate the accuracy of the calculator in predicting postoperative complications in patients undergoing common bile duct (CBD) exploration.
A retrospective chart review was completed for 305 patients that underwent open and laparoscopic CBD exploration at a single institution from 2010 to 2018. Patient demographics and preoperative risk factors were entered into the calculator, and the predicted complication risks were compared with observed complication rates. Brier score, C-statistic, and Hosmer-Lemeshow regression analysis were used to assess discrimination and calibration.
The observed rate exceeded the predicted rate for any complication (35.1% vs. 21%), return to operating room (5.9% vs. 3.6%), death (3.3% vs. 1%), and sepsis (3% vs. 2.4%). The model performed best in predicting serious complication (Brier 0.087, C-statistic 0.818, Hosmer-Lemeshow 0.695), surgical site infection (Brier 0.068, C-statistic 0.670, Hosmer-Lemeshow 0.292), discharge to rehabilitation facility (Brier 0.041, C-statistic 0.907, Hosmer-Lemeshow 0.638), and death (Brier 0.028, C-statistic 0.898, Hosmer-Lemeshow 0.004). In multivariable analysis, there was no statistically significant predicted complication type that affected the type of surgery.
The calculator was accurate in predicting serious complication, surgical site infection, discharge to rehabilitation facility, and death. However, the model displayed poor predictive ability in all other complications that were analyzed.
美国外科医师学院国家外科质量改进计划（ACS NSQIP）手术风险计算器是一种风险分层工具，可帮助预测术后并发症的风险，这对于知情决策很重要。本研究的目的是评估该计算器在预测接受常规胆管（CBD）探查的患者术后并发症方面的准确性。
对 2010 年至 2018 年在一家机构接受开放和腹腔镜 CBD 探查的 305 例患者进行了回顾性图表审查。将患者的人口统计学和术前危险因素输入计算器，并将预测的并发症风险与观察到的并发症发生率进行比较。使用 Brier 评分、C 统计量和 Hosmer-Lemeshow 回归分析来评估判别和校准。
任何并发症的观察发生率均超过预测发生率（35.1%比 21%），重返手术室（5.9%比 3.6%），死亡（3.3%比 1%）和脓毒症（3%比 2.4%）。该模型在预测严重并发症（Brier 0.087、C 统计量 0.818、Hosmer-Lemeshow 0.695）、手术部位感染（Brier 0.068、C 统计量 0.670、Hosmer-Lemeshow 0.292）、康复设施出院（Brier 0.041、C 统计量 0.907、Hosmer-Lemeshow 0.638）和死亡（Brier 0.028、C 统计量 0.898、Hosmer-Lemeshow 0.004）方面表现最佳。多变量分析显示，没有统计学意义的预测并发症类型会影响手术类型。
该计算器在预测严重并发症、手术部位感染、康复设施出院和死亡方面具有准确性。然而，该模型在分析的所有其他并发症方面显示出较差的预测能力。
