Laane Charlotte L E, Van Lieshout Esther M M, Van Heeswijk Roos A M, De Jong Amber I, Verhofstad Michael H J, Wijffels Mathieu M E
Trauma Research Unit Dept. of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Heliyon. 2024 Feb 3;10(4):e25796. doi: 10.1016/j.heliyon.2024.e25796. eCollection 2024 Feb 29.
This retrospective study aimed to validate the ACS NSQIP Surgical Risk Calculator (SCR) to predict 30-day postoperative outcomes in patients with one of the following subacute orthopedic trauma diagnoses; multiple rib fractures, pelvic ring/acetabular fracture, or unilateral femoral fracture.
Data of patients with these diagnoses treated between January 1, 2015 and September 19, 2020 were extracted from the patients' medical files. Diagnostic performance, discrimination, calibration, and accuracy of the ACS NSQIP SRC to predict specific outcomes developing within 30 days after surgery was determined.
The total cohort of the three diagnoses consisted of 435 patients. ACS NSQIP SRC underestimated the risk for serious complications, especially in patients with multiple rib fractures (8.3% predicted vs 17.2% observed) or pelvic ring/acetabular fracture (6.1% vs 19.8%). Underestimation was more pronounced for the composite outcome 'any complication'. Sensitivity ranged from 16.7% to 100% and specificity from 41.1% to 97.1%. Specificity exceeded sensitivity for pelvic ring/acetabular and femoral fractures. Discrimination was good for predicting death (femoral fracture), fair for readmission (femoral fracture), serious complication (multiple rib fractures), and any complication (multiple rib fractures), but poor in all other outcomes and diagnoses. Calibration and accuracy were adequate for all three diagnoses (p-value for Hosmer-Lemeshow test >0.05 and Brier scores <0.25).
Performance of the ACS NSQIP SRC in the studied cohort was variable for all three diagnoses. Although it underestimated the risk of most outcomes, calibration and accuracy seemed generally adequate. For most outcomes, adequate diagnostic performance and discrimination could not be confirmed.
本回顾性研究旨在验证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（SCR），以预测患有以下亚急性骨科创伤诊断之一的患者术后30天的结局；多根肋骨骨折、骨盆环/髋臼骨折或单侧股骨骨折。
从患者病历中提取2015年1月1日至2020年9月19日期间接受治疗的这些诊断患者的数据。确定了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）预测术后30天内出现的特定结局的诊断性能、区分能力、校准和准确性。
这三种诊断的总队列包括435名患者。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低估了严重并发症的风险，尤其是在多根肋骨骨折患者中（预测为8.3%，观察到为17.2%）或骨盆环/髋臼骨折患者中（6.1%对19.8%）。对于复合结局“任何并发症”，低估更为明显。敏感性范围为16.7%至100%，特异性范围为41.1%至97.1%。骨盆环/髋臼骨折和股骨骨折的特异性超过敏感性。区分能力在预测死亡（股骨骨折）方面良好，在预测再入院（股骨骨折）、严重并发症（多根肋骨骨折）和任何并发症（多根肋骨骨折）方面中等，但在所有其他结局和诊断中较差。所有三种诊断的校准和准确性均足够（Hosmer-Lemeshow检验的p值>0.05，Brier评分<0.25）。
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在所研究队列中对所有三种诊断的表现各不相同。尽管它低估了大多数结局的风险，但校准和准确性总体上似乎足够。对于大多数结局，无法确认有足够的诊断性能和区分能力。
