抱最好的希望，做最坏的打算——美国外科医师学会国家外科质量改进计划的诊断准确性——减重术后接受腹壁成形术患者的风险模型——一项回顾性队列研究的结果
Hope for the best, but prepare for the worst - Diagnostic accuracy of the American College of Surgeons National Surgical Quality Improvement Program - Risk model for patients undergoing abdominoplasty after massive weight loss - Results from a Retrospective Cohort Study.
作者信息
Schulz Torsten, Kirsten Toralf, Langer Stefan, Nuwayhid Rima
机构信息
Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany.
Medical Informatics Center - Department of Medical Data Science, University Hospital Leipzig, 04103, Leipzig 04103, Germany.
出版信息
JPRAS Open. 2024 Dec 10;43:347-356. doi: 10.1016/j.jpra.2024.12.002. eCollection 2025 Mar.
BACKGROUND
This study aimed to validate the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator for predicting outcomes in patients undergoing abdominoplasty after massive weight loss.
METHODS
Patients' characteristics, pre-existing comorbidities and adverse outcomes in our department from 2013 to 2023 were collected retrospectively. Adverse events were defined according to ACS-NSQIP standards and predicted risks were calculated manually using the ACS-NSQIP risk calculator. Binary logistic regression and the Brier score were used to assess the diagnostic accuracy of the model.
RESULTS
Among the 337 individuals who underwent abdominoplasty, 251 had achieved significant weight loss before surgery. After excluding 46 cases due to incomplete data, 205 cases remained for analysis. There were 20% cases of serious complications, 26.3% of some complications, 10.2% of readmissions, 18.8% returned to the operating theatre, 15.6% of surgical site infections and 0.5% each of pneumonia and venous thromboembolism. Although the calculator predicted a 1.5% discharge rate to nursing or rehabilitation facilities and a 0.1% rate of sepsis, neither outcome was observed. Elevated American Society of Anesthesiologists (ASA) status was significantly associated with a higher complication rate, except for surgical site infections (SSI) ( = 0.06). Additionally, an elevated Body Mass Index (BMI) before post-bariatric surgery and a higher resection weight were both associated with increased rates of return to the operating theatre ( = 0.01) and serious complications ( = 0.01). Predicted complication rates (0.1%-8.6%) underestimated actual complication rates (0.5%-26.3%). The Brier scores did not differ significantly from the null model for any outcomes except for general complications ( = 0.001) and logistic regression models demonstrated low sensitivity (0.0-9.8%) and weak odds ratios (1.28-1.46), indicating limited reliability.
CONCLUSION
The ACS-NSQIP risk calculator does not reliably predict adverse outcomes in this patient cohort.
背景
本研究旨在验证美国外科医师学会（ACS）国家外科质量改进计划（NSQIP）风险计算器在预测大量体重减轻后接受腹壁成形术患者预后方面的有效性。
方法
回顾性收集2013年至2023年我院患者的特征、既往合并症和不良结局。不良事件根据ACS-NSQIP标准定义，并使用ACS-NSQIP风险计算器手动计算预测风险。采用二元逻辑回归和Brier评分评估模型的诊断准确性。
结果
在337例行腹壁成形术的患者中，251例术前体重显著减轻。排除46例数据不完整的病例后，剩余205例进行分析。严重并发症发生率为20%，部分并发症发生率为26.3%，再入院率为10.2%，返回手术室率为18.8%，手术部位感染率为15.6%，肺炎和静脉血栓栓塞发生率均为0.5%。尽管该计算器预测转至护理或康复机构的出院率为1.5%，败血症发生率为0.1%，但均未观察到这些结局。除手术部位感染外（P = 0.06），美国麻醉医师协会（ASA）分级升高与较高的并发症发生率显著相关。此外，减重手术后的术前体重指数（BMI）升高和切除重量增加均与返回手术室率（P = 0.01）和严重并发症发生率（P = 0.01）增加相关。预测并发症发生率（0.1%-8.6%）低于实际并发症发生率（0.5%-26.3%）。除一般并发症外（P = 0.001），Brier评分与无效模型在任何结局方面均无显著差异，逻辑回归模型显示敏感性较低（0.0-9.8%），优势比较弱（1.28-1.46），表明可靠性有限。
结论
ACS-NSQIP风险计算器不能可靠地预测该患者队列中的不良结局。
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