Goodwin Alyssa M, Kurapaty Steven S, Inglis Jacqueline E, Divi Srikanth N, Patel Alpesh A, Hsu Wellington K
Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
Surg Pract Sci. 2024 Feb 13;16:100238. doi: 10.1016/j.sipas.2024.100238. eCollection 2024 Mar.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) provides risk estimates of postoperative complications. While several studies have examined the accuracy of the ACS-Surgical Risk Calculator (SRC) within a single specialty, the respective conclusions are limited by sample size. We sought to conduct a meta-analysis to determine the accuracy of the ACS-SRC among various surgical specialties.
Clinical studies that utilized the ACS-SRC, predicted complication rates compared to actual rates, and analyzed at least one metric reported by ACS-SRC met the inclusion criteria. Data for each specialty were pooled using the DerSimonian and Laird random-effect models and analyzed with the binary random-effect model to produce risk difference (RD) and 95 % confidence intervals (CIs) using Open Meta[A].
The initial search yielded 281 studies and, after applying inclusion and exclusion criteria, a total of 53 studies remained with a total sample of 30,134 patients spanning 10 surgical specialties. When considering any complication and death, the ACS-SRC significantly underpredicted complications for: Orthopaedic Surgery (RD -0.067, = 0.008), Spine (RD -0.027, < 0.001), Urology (RD -0.03, < 0.001), Surgical Oncology (RD -0.045, < 0.001), and Gynecology (RD -0.098, = 0.01).
The ACS-SRC proved useful in General, Acute Care, Colorectal, Otolaryngology, and Cardiothoracic Surgery, but significantly underpredicted complication rates in Spine, Orthopaedics, Urology, Surgical Oncology, and Gynecology. These data indicate the ACS-SRC is a reliable predictor in some specialties, but its use should be cautioned in the remaining specialties evaluated here.
美国外科医师学会国家外科质量改进计划（ACS - NSQIP）提供术后并发症的风险评估。虽然有几项研究在单一专科内检验了ACS手术风险计算器（SRC）的准确性，但各自的结论受样本量限制。我们试图进行一项荟萃分析，以确定ACS - SRC在各外科专科中的准确性。
使用ACS - SRC、将预测并发症发生率与实际发生率进行比较，并分析ACS - SRC报告的至少一项指标的临床研究符合纳入标准。各专科的数据使用DerSimonian和Laird随机效应模型进行汇总，并使用二元随机效应模型进行分析，以使用Open Meta[A]得出风险差异（RD）和95%置信区间（CI）。
初步检索产生了281项研究，在应用纳入和排除标准后，共保留了53项研究，总样本量为30134例患者，涵盖10个外科专科。在考虑任何并发症和死亡情况时，ACS - SRC显著低估了以下专科的并发症：骨科手术（RD -0.067， = 0.008）、脊柱手术（RD -0.027， < 0.001）、泌尿外科手术（RD -0.03， < 0.001）、外科肿瘤学（RD -0.045， < 0.001）和妇科手术（RD -0.098， = 0.01）。
ACS - SRC在普通外科、急性护理外科、结直肠外科、耳鼻喉科和心胸外科中被证明是有用的，但在脊柱外科、骨科、泌尿外科、外科肿瘤学和妇科中显著低估了并发症发生率。这些数据表明，ACS - SRC在某些专科中是可靠的预测工具，但在此评估的其余专科中使用时应谨慎。
