Holm Sebastian, Löfgren Jenny, Zdolsek Johann, Berner Juan Enrique, Landström Fredrik
From the Department of Plastic and Reconstructive Surgery, Örebro University Hospital, Örebro, Sweden.
Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Plast Reconstr Surg Glob Open. 2025 Jun 26;13(6):e6910. doi: 10.1097/GOX.0000000000006910. eCollection 2025 Jun.
Head and neck cancer (HNC) is the seventh most prevalent cancer worldwide, usually requiring a multidisciplinary approach. The National Surgical Quality Improvement Program (NSQIP) risk calculator is a tool for predicting postoperative complications that possibly can help in decision-making, support patient education, and guide the choice between surgical and nonsurgical treatment options. The aim of this study was to assess the reliability of the NSQIP risk calculator as a predictor of postoperative complications following head and neck surgery with microvascular reconstruction.
This retrospective study included 99 patients diagnosed with HNC who underwent microvascular reconstruction from January 2016 to February 2021. The observed complications were compared with those predicted by the NSQIP calculator. To assess the discriminatory power of the NSQIP estimates, receiver operating characteristic statistics, logistic regression, and the overall Brier score were used.
Forty-four percent of the patients experienced at least 1 postoperative complication, and 27.2% developed serious complications. The receiver operating characteristic analysis for any complications revealed an area under the curve (AUC) of 0.62 (95% confidence interval 0.51-0.73, = 0.046). For serious complications, the AUC was 0.65 (95% confidence interval, 0.52-0.79, = 0.021). Both AUC values fell short of the threshold for "acceptable discrimination" (0.7-0.8). The overall Brier score was 0.32, with scores less than 0.09 considered to have good accuracy.
The results suggest that the NSQIP risk calculator tends to underestimate the likelihood of postoperative complications in patients who are undergoing resection for HNC accompanied by microvascular reconstruction.
头颈癌（HNC）是全球第七大常见癌症，通常需要多学科治疗方法。国家外科质量改进计划（NSQIP）风险计算器是一种预测术后并发症的工具，可能有助于决策制定、支持患者教育，并指导手术和非手术治疗方案的选择。本研究的目的是评估NSQIP风险计算器作为微血管重建头颈手术后预测术后并发症的可靠性。
这项回顾性研究纳入了99例2016年1月至2021年2月期间诊断为HNC并接受微血管重建的患者。将观察到的并发症与NSQIP计算器预测的并发症进行比较。为了评估NSQIP估计值的鉴别力，使用了受试者工作特征统计、逻辑回归和总体布里尔评分。
44%的患者至少经历了1种术后并发症，27.2%的患者出现了严重并发症。任何并发症的受试者工作特征分析显示曲线下面积（AUC）为0.62（95%置信区间0.51-0.73，P = 0.046）。对于严重并发症，AUC为0.65（95%置信区间0.52-0.79，P = 0.021）。两个AUC值均未达到“可接受鉴别力”的阈值（0.7-0.8）。总体布里尔评分为0.32，评分小于0.09被认为具有良好的准确性。
结果表明，NSQIP风险计算器往往低估了接受HNC切除并伴有微血管重建患者术后并发症的可能性。
