Performance of the American College of Surgeons NSQIP Surgical Risk Calculator for Total Gastrectomy - 23/11/20

Doi : 10.1016/j.jamcollsurg.2020.09.023

Elvira L. Vos, MD, PhD ^a, Ashley E. Russo, MD ^a, Alexandra Hohmann, BA ^a, Sam S. Yoon, MD, FACS ^a, Daniel G. Coit, MD, FACS ^a, Clifford Y. Ko, MD, FACS ^b,^c, Vivian E. Strong, MD, FACS ^a,^⁎
^a Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
^b Department of Surgery, University of California Los Angeles Medical Center, Los Angeles, CA
^c Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL

^∗Correspondence address: Vivian Strong, MD, FACS, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065.Department of SurgeryMemorial Sloan Kettering Cancer Center1275 York AveNew YorkNY10065

Abstract

Background

To encourage implementation of the American College of Surgeons (ACS) NSQIP Risk Calculator for total gastrectomy for gastric cancer, its predictive performance for this specific procedure should be validated. We assessed its discriminatory accuracy and goodness of fit for predicting 12 adverse outcomes.

Study Design

Data were collected on all patients with gastric cancer who underwent total gastrectomy with curative intent at Memorial Sloan Kettering Cancer Center between 2002 and 2017. Preoperative risk factors from the electronic medical record were manually inserted into the ACS-NSQIP Risk Calculator. Predictions for adverse outcomes were compared with observed outcomes by Brier scores, c-statistics, and Hosmer-Lemeshow p value.

Results

In a total of 452 patients, the predicted rate of all complications (29%) was lower than the observed rate (45%). Brier scores varied between 0.017 for death and 0.272 for any complication. C-statistics were moderate (0.7–0.8) for death and renal failure, good (0.8–0.9) for cardiac complication, and excellent (≥0.9) for discharge to nursing or rehabilitation facility. Hosmer-Lemeshow p value found poor goodness of fit for pneumonia only.

Conclusions

For adverse outcomes after total gastrectomy with curative intent in gastric cancer patients, performance of the ACS-NSQIP Risk Calculator is variable. Its predictive performance is best for cardiac complications, renal failure, death, and discharge to nursing or rehabilitation facility.

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