Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Head Neck. 2024 Jul;46(7):1718-1726. doi: 10.1002/hed.27765. Epub 2024 Apr 4.
The National Surgical Quality Improvement Program surgical risk calculator (SRC) estimates the risk for postoperative complications. This meta-analysis assesses the efficacy of the SRC in the field of head and neck surgery.
A systematic review identified studies comparing the SRC's predictions to observed outcomes following head and neck surgeries. Predictive accuracy was assessed using receiver operating characteristic curves (AUCs) and Brier scoring.
Nine studies totaling 1774 patients were included. The SRC underpredicted the risk of all outcomes (including any complication [observed (ob) = 35.9%, predicted (pr) = 21.8%] and serious complication [ob = 28.7%, pr = 17.0%]) except mortality (ob = 0.37%, pr = 1.55%). The observed length of stay was more than twice the predicted length (p < 0.02). Discrimination was acceptable for postoperative pneumonia (AUC = 0.778) and urinary tract infection (AUC = 0.782) only. Predictive accuracy was low for all outcomes (Brier scores ≥0.01) and comparable for patients with and without free-flap reconstructions.
The SRC is an ineffective instrument for predicting outcomes in head and neck surgery.
国家外科质量改进计划手术风险计算器（SRC）可估计术后并发症的风险。本荟萃分析评估了 SRC 在头颈部手术领域的疗效。
系统评价确定了比较 SRC 预测与头颈部手术后观察结果的研究。使用接收者操作特征曲线（AUC）和 Brier 评分评估预测准确性。
共纳入 9 项研究，总计 1774 例患者。SRC 低估了所有结局（包括任何并发症[观察（ob）=35.9%，预测（pr）=21.8%]和严重并发症[ob=28.7%，pr=17.0%]），但死亡率除外（ob=0.37%，pr=1.55%）。观察到的住院时间是预测住院时间的两倍多（p<0.02）。术后肺炎（AUC=0.778）和尿路感染（AUC=0.782）的区分度仅可接受。所有结局的预测准确性均较低（Brier 评分≥0.01），且有和无游离皮瓣重建的患者之间相当。
SRC 是预测头颈部手术结果的无效工具。
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