Validation of a risk prediction calculator in Australian patients undergoing head and neck microsurgery reconstruction.

Australia / epidemiology Humans Microsurgery / adverse effects Postoperative Complications / epidemiology Quality Improvement Retrospective Studies Risk Assessment / methods Risk Factors
Free tissue flaps Head Neck Postoperative outcomes Risk

Journal

Journal of plastic, reconstructive & aesthetic surgery : JPRAS
ISSN: 1878-0539
Titre abrégé: J Plast Reconstr Aesthet Surg
Pays: Netherlands
ID NLM: 101264239

Informations de publication

Date de publication:
09 2022
Historique:
received: 04 12 2021
revised: 16 04 2022
accepted: 26 04 2022
pubmed: 30 6 2022
medline: 12 10 2022
entrez: 29 6 2022
Statut: ppublish

Résumé

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator (SRC) is an open access calculator predicting patients' risk of postoperative complications. This study aims to assess the validity of the SRC in patients undergoing microsurgical free flap reconstruction at an Australian tertiary referral centre. This is a retrospective cohort study of 200 consecutive patients treated up to November 2020. SRC-predicted rates of postoperative complications and hospital length of stay (LOS) were compared to those observed for the ablative and reconstructive components of the procedure. The performance of the SRC was assessed using Brier scores, area under the receiver operating characteristic (ROC) curve (AUC), and the Hosmer-Lemeshow test. For both ablative and reconstructive components, the SRC discriminates well for pneumonia and urinary tract infection, and it is calibrated well for readmission and sepsis, but it does not discriminate and calibrate well for any single outcome. SRC-predicted hospital LOS and actual LOS did not correlate well for the reconstructive component, but they correlated strongly for the ablative component. The SRC is a poor predictor of postoperative complication rates and hospital LOS in patients undergoing head and neck microsurgical reconstruction.

Sections du résumé

BACKGROUND
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator (SRC) is an open access calculator predicting patients' risk of postoperative complications. This study aims to assess the validity of the SRC in patients undergoing microsurgical free flap reconstruction at an Australian tertiary referral centre.
METHODS
This is a retrospective cohort study of 200 consecutive patients treated up to November 2020. SRC-predicted rates of postoperative complications and hospital length of stay (LOS) were compared to those observed for the ablative and reconstructive components of the procedure. The performance of the SRC was assessed using Brier scores, area under the receiver operating characteristic (ROC) curve (AUC), and the Hosmer-Lemeshow test.
RESULTS
For both ablative and reconstructive components, the SRC discriminates well for pneumonia and urinary tract infection, and it is calibrated well for readmission and sepsis, but it does not discriminate and calibrate well for any single outcome. SRC-predicted hospital LOS and actual LOS did not correlate well for the reconstructive component, but they correlated strongly for the ablative component.
CONCLUSIONS
The SRC is a poor predictor of postoperative complication rates and hospital LOS in patients undergoing head and neck microsurgical reconstruction.

Identifiants

DOI: 10.1016/j.bjps.2022.04.073 PMID: 35768291
pubmed: 35768291
pii: S1748-6815(22)00271-6
doi: 10.1016/j.bjps.2022.04.073
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

3323-3329

Informations de copyright

Copyright © 2022 Elsevier Ltd. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest No conflicts of interest have been declared.

Auteurs

Amanda E Yung (AE)

The University of Sydney Sydney Medical School, Sydney, Australia; The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia.

Gerald Wong (G)

Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia.

Neil Pillinger (N)

Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia.

James Wykes (J)

Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia.

Roger Haddad (R)

Department of Plastics and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia.

Stephanie McInnes (S)

Department of Anaesthetics, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia.

Carsten E Palme (CE)

Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia.

Tsu-Hui Hubert Low (TH)

Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia.

Jonathan R Clark (JR)

The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia.

Robert Sanders (R)

The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia.

Sydney Ch'ng (S)

The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Plastics and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Melanoma Institute of Australia, Sydney, Australia. Electronic address: sydney.chng@sydney.edu.au.

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Classifications MeSH

questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › Validation of a risk prediction calculator in...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Validation of a risk prediction calculator in...
questionsmedicales.fr › Techniques d'investigation › Micromanipulation › Microchirurgie › Validation of a risk prediction calculator in...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Complications postopératoires › Validation of a risk prediction calculator in...
questionsmedicales.fr › Administration des services de santé › Amélioration de la qualité › Validation of a risk prediction calculator in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Validation of a risk prediction calculator in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Appréciation des risques › Validation of a risk prediction calculator in...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Validation of a risk prediction calculator in...