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- Title
Evaluating the ACS-NSQIP Risk Calculator in Primary GI Neuroendocrine Tumor: Results from the United States Neuroendocrine Tumor Study Group.
- Authors
ARMSTRONG, EMILY A.; BEAL, ELIZAW.; LOPEZ-AGUIAR, ALEXANDRA G.; POULTSIDES, GEORGE; CANNON, JOHN G.; ROCHA, FLAVIO; CROWN, ANGELENA; BARRETT, JAMES; RONNKLEIV-KELLY, SEAN; FIELDS, RYAN C.; KRASNICK, BRADLEY A.; IDREES, KAMRAN; SMITH, PAULA MARINCOLA; NATHAN, HARI; BEEMS, MEGAN V.; MAITHEL, SHISHIR K.; SCHMIDT, CARL R.; PAWLIK, TIMOTHY M.; DILLHOFF, MARY; Beal, Eliza W
- Abstract
The ACS established an online risk calculator to help surgeons make patient-specific estimates of postoperative morbidity and mortality. Our objective was to assess the accuracy of the ACS-NSQIP calculator for estimating risk after curative intent resection for primary GI neuroendocrine tumors (GI-NETs). Adult patients with GI-NET who underwent complete resection from 2000 to 2017 were identified using a multi-institutional database, including data from eight academic medical centers. The ability of the NSQIP calculator to accurately predict a particular outcome was assessed using receiver operating characteristic curves and the area under the curve (AUC). Seven hundred three patients were identified who met inclusion criteria. The most commonly performed procedures were resection of the small intestine with anastomosis (N = 193, 26%) and partial colectomy with anastomosis (N = 136, 18%). The majority of patients were younger than 65 years (N = 482, 37%) and ASA Class III (N = 337, 48%). The most common comorbidities were diabetes (N = 128, 18%) and hypertension (N = 395, 56%). Complications among these patients based on ACS NSQIP definitions included any complication (N = 132, 19%), serious complication (N = 118, 17%), pneumonia (N = 7, 1.0%), cardiac complication (N = 1, 0.01%), SSI (N = 80, 11.4%), UTI (N = 17, 2.4%), venous thromboembolism (N = 18, 2.5%), renal failure (N = 16, 2.3%), return to the operating room (N = 27, 3.8%), discharge to nursing/rehabilitation (N = 22, 3.1%), and 30-day mortality (N = 9, 1.3%). The calculator provided reasonable estimates of risk for pneumonia (AUC = 0.721), cardiac complication (AUC = 0.773), UTI (AUC = 0.716), and discharge to nursing/rehabilitation (AUC = 0.779) and performed poorly (AUC < 0.7) for all other complications Fig. 1). The ACS-NSQIP risk calculator estimates a similar proportion of risk to actual events in patients with GI-NET but has low specificity for identifying the correct patients for many types of complications. The risk calculator may require modification for some patient populations.
- Subjects
UNITED States; NEUROENDOCRINE tumors; RECEIVER operating characteristic curves; MOSQUITO nets; ACADEMIC medical centers; CALCULATORS; RISK assessment; SURGICAL complications; GASTROINTESTINAL tumors; TREATMENT effectiveness; RETROSPECTIVE studies; DISEASE complications
- Publication
American Surgeon, 2019, Vol 85, Issue 12, p1334
- ISSN
0003-1348
- Publication type
journal article
- DOI
10.1177/000313481908501225