Predicted versus observed 30-day perioperative outcomes using the ACS NSQIP surgical risk calculator in patients undergoing partial nephrectomy for renal cell carcinoma
Purpose The purpose of the study was to evaluate the accuracy of the American College of Surgeons NSQIP Surgical Risk Calculator for predicting risk-adjusted 30-day outcomes for patients undergoing partial nephrectomy (PN) for renal cell carcinoma (RCC). Methods A single institution, multi-surgeon,...
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| Veröffentlicht in: | International urology and nephrology 2018-07, Vol.50 (7), p.1249-1256 |
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| creator | Blair, Brian M. Lehman, Erik B. Jafri, Syed M. Kaag, Matthew G. Raman, Jay D. |
| description | Purpose
The purpose of the study was to evaluate the accuracy of the American College of Surgeons NSQIP Surgical Risk Calculator for predicting risk-adjusted 30-day outcomes for patients undergoing partial nephrectomy (PN) for renal cell carcinoma (RCC).
Methods
A single institution, multi-surgeon, prospectively maintained database was queried for patients undergoing PN for RCC from 1998 to 2015. 21 preoperative factors were analyzed for each patient with predicted risk for 30-day complications, mortality, and length of stay (LOS) calculated. Differences between the mean predicted risk and observed rate of surgical outcomes were determined using two-sided one-sample
t
test with significance at
p
|
| doi_str_mv | 10.1007/s11255-018-1898-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2050481546</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2050481546</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-1edacd49c575a01b9f01dc3db64ca20c6b5bcbd8f3e680226b919d0b1314f6fe3</originalsourceid><addsrcrecordid>eNp1kc9u1DAQxi0EokvhAbggS1y4BMZ2nDjHalWgUgVFhXPk2JOtyyYO_rPSvhGPiaMtICFxmbHHv-_zSB8hLxm8ZQDtu8gYl7ICpiqmOlU1j8iGyVZUXKr6MdmAAFaxhosz8izGewDoFMBTcsY71ahOqA35eRPQOpPQ0gOGmCP1Q8RwKHcBldVHumBwvhSd3AGpz8n4CSPN0c07mu6QXmxv6afbL1c3NOawc0bvaXDxOy0Hk_c6-UDdTJeixzkV4Wwx7PyqXnRIruAzLncBTfLTkY4FDziXqcF9KToYN_tJPydPRr2P-OKhn5Nv7y-_bj9W158_XG0vrisjWp4qhlYbW3dGtlIDG7oRmDXCDk1tNAfTDHIwg1WjwEYB583Qsc7CwASrx2ZEcU7enHyX4H9kjKmfXFxX0TP6HHsOEmrFZN0U9PU_6L3Poay-UnXXSlCqLhQ7USb4GAOO_RLcpMOxZ9CvMfanGPsSY7_G2K_Orx6c8zCh_aP4nVsB-AmI5WneYfj79f9dfwENeKuo</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2049750884</pqid></control><display><type>article</type><title>Predicted versus observed 30-day perioperative outcomes using the ACS NSQIP surgical risk calculator in patients undergoing partial nephrectomy for renal cell carcinoma</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Blair, Brian M. ; Lehman, Erik B. ; Jafri, Syed M. ; Kaag, Matthew G. ; Raman, Jay D.</creator><creatorcontrib>Blair, Brian M. ; Lehman, Erik B. ; Jafri, Syed M. ; Kaag, Matthew G. ; Raman, Jay D.</creatorcontrib><description><![CDATA[Purpose
The purpose of the study was to evaluate the accuracy of the American College of Surgeons NSQIP Surgical Risk Calculator for predicting risk-adjusted 30-day outcomes for patients undergoing partial nephrectomy (PN) for renal cell carcinoma (RCC).
Methods
A single institution, multi-surgeon, prospectively maintained database was queried for patients undergoing PN for RCC from 1998 to 2015. 21 preoperative factors were analyzed for each patient with predicted risk for 30-day complications, mortality, and length of stay (LOS) calculated. Differences between the mean predicted risk and observed rate of surgical outcomes were determined using two-sided one-sample
t
test with significance at
p
< 0.05. Subgroup analyses of outcomes stratified by surgical approach were also performed.
Results
470 patients undergoing PN for RCC were analyzed. Comparing NSQIP predicted to observed outcomes, clinically significant underestimations occurred with rates of overall complications (9.16 vs. 16.81%,
p
< 0.001), surgical site infections [SSI] (1.65 vs. 2.77%,
p
< 0.001), urinary tract infection [UTI] (1.41 vs. 3.40%,
p
< 0.001), and LOS (3.25 vs. 3.73 days,
p
< 0.001). On subgroup analysis, 209 open PN and 261 minimally invasive PN (MIPN) were performed. The NSQIP calculator consistently underestimated overall complications, SSI, UTI, and LOS (
p
< 0.001) among both surgical approaches, while overestimating MIPN severe complications (
p
< 0.001). Clinically important differences persisted when stratifying the MIPN group by laparoscopic (
N
= 111) and robotic (
N
= 150) approaches.
Conclusions
The ACS NSQIP Surgical Risk Calculator had significant discrepancies among observed and predicted outcomes. Additional analyses confirmed these differences remained significant irrespective of surgical approach. These findings emphasize the need for urologic oncology-specific calculators to better predict surgical outcomes in this complex patient population.]]></description><identifier>ISSN: 0301-1623</identifier><identifier>EISSN: 1573-2584</identifier><identifier>DOI: 10.1007/s11255-018-1898-6</identifier><identifier>PMID: 29868938</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Academic Medical Centers ; Aged ; Carcinoma, Renal Cell - mortality ; Carcinoma, Renal Cell - pathology ; Carcinoma, Renal Cell - surgery ; Cohort Studies ; Computers ; Databases, Factual ; Female ; Follow-Up Studies ; Humans ; Kidney cancer ; Kidney Neoplasms - mortality ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Laparoscopy ; Laparoscopy - methods ; Laparotomy - methods ; Length of Stay ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Nephrectomy ; Nephrectomy - adverse effects ; Nephrectomy - methods ; Nephrology ; Patients ; Postoperative Complications - epidemiology ; Postoperative Complications - physiopathology ; Predictive Value of Tests ; Preoperative Care ; Prospective Studies ; Renal cell carcinoma ; Risk Assessment - methods ; Robotic surgery ; Robotic Surgical Procedures - methods ; Surgical outcomes ; Surgical site infections ; Time Factors ; United States ; Urinary tract ; Urinary tract infections ; Urology ; Urology - Original Paper</subject><ispartof>International urology and nephrology, 2018-07, Vol.50 (7), p.1249-1256</ispartof><rights>Springer Science+Business Media B.V., part of Springer Nature 2018</rights><rights>International Urology and Nephrology is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-1edacd49c575a01b9f01dc3db64ca20c6b5bcbd8f3e680226b919d0b1314f6fe3</citedby><cites>FETCH-LOGICAL-c372t-1edacd49c575a01b9f01dc3db64ca20c6b5bcbd8f3e680226b919d0b1314f6fe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11255-018-1898-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11255-018-1898-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29868938$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Blair, Brian M.</creatorcontrib><creatorcontrib>Lehman, Erik B.</creatorcontrib><creatorcontrib>Jafri, Syed M.</creatorcontrib><creatorcontrib>Kaag, Matthew G.</creatorcontrib><creatorcontrib>Raman, Jay D.</creatorcontrib><title>Predicted versus observed 30-day perioperative outcomes using the ACS NSQIP surgical risk calculator in patients undergoing partial nephrectomy for renal cell carcinoma</title><title>International urology and nephrology</title><addtitle>Int Urol Nephrol</addtitle><addtitle>Int Urol Nephrol</addtitle><description><![CDATA[Purpose
The purpose of the study was to evaluate the accuracy of the American College of Surgeons NSQIP Surgical Risk Calculator for predicting risk-adjusted 30-day outcomes for patients undergoing partial nephrectomy (PN) for renal cell carcinoma (RCC).
Methods
A single institution, multi-surgeon, prospectively maintained database was queried for patients undergoing PN for RCC from 1998 to 2015. 21 preoperative factors were analyzed for each patient with predicted risk for 30-day complications, mortality, and length of stay (LOS) calculated. Differences between the mean predicted risk and observed rate of surgical outcomes were determined using two-sided one-sample
t
test with significance at
p
< 0.05. Subgroup analyses of outcomes stratified by surgical approach were also performed.
Results
470 patients undergoing PN for RCC were analyzed. Comparing NSQIP predicted to observed outcomes, clinically significant underestimations occurred with rates of overall complications (9.16 vs. 16.81%,
p
< 0.001), surgical site infections [SSI] (1.65 vs. 2.77%,
p
< 0.001), urinary tract infection [UTI] (1.41 vs. 3.40%,
p
< 0.001), and LOS (3.25 vs. 3.73 days,
p
< 0.001). On subgroup analysis, 209 open PN and 261 minimally invasive PN (MIPN) were performed. The NSQIP calculator consistently underestimated overall complications, SSI, UTI, and LOS (
p
< 0.001) among both surgical approaches, while overestimating MIPN severe complications (
p
< 0.001). Clinically important differences persisted when stratifying the MIPN group by laparoscopic (
N
= 111) and robotic (
N
= 150) approaches.
Conclusions
The ACS NSQIP Surgical Risk Calculator had significant discrepancies among observed and predicted outcomes. Additional analyses confirmed these differences remained significant irrespective of surgical approach. These findings emphasize the need for urologic oncology-specific calculators to better predict surgical outcomes in this complex patient population.]]></description><subject>Academic Medical Centers</subject><subject>Aged</subject><subject>Carcinoma, Renal Cell - mortality</subject><subject>Carcinoma, Renal Cell - pathology</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Cohort Studies</subject><subject>Computers</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Kidney cancer</subject><subject>Kidney Neoplasms - mortality</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Laparotomy - methods</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nephrectomy</subject><subject>Nephrectomy - adverse effects</subject><subject>Nephrectomy - methods</subject><subject>Nephrology</subject><subject>Patients</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Predictive Value of Tests</subject><subject>Preoperative Care</subject><subject>Prospective Studies</subject><subject>Renal cell carcinoma</subject><subject>Risk Assessment - methods</subject><subject>Robotic surgery</subject><subject>Robotic Surgical Procedures - methods</subject><subject>Surgical outcomes</subject><subject>Surgical site infections</subject><subject>Time Factors</subject><subject>United States</subject><subject>Urinary tract</subject><subject>Urinary tract infections</subject><subject>Urology</subject><subject>Urology - Original Paper</subject><issn>0301-1623</issn><issn>1573-2584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kc9u1DAQxi0EokvhAbggS1y4BMZ2nDjHalWgUgVFhXPk2JOtyyYO_rPSvhGPiaMtICFxmbHHv-_zSB8hLxm8ZQDtu8gYl7ICpiqmOlU1j8iGyVZUXKr6MdmAAFaxhosz8izGewDoFMBTcsY71ahOqA35eRPQOpPQ0gOGmCP1Q8RwKHcBldVHumBwvhSd3AGpz8n4CSPN0c07mu6QXmxv6afbL1c3NOawc0bvaXDxOy0Hk_c6-UDdTJeixzkV4Wwx7PyqXnRIruAzLncBTfLTkY4FDziXqcF9KToYN_tJPydPRr2P-OKhn5Nv7y-_bj9W158_XG0vrisjWp4qhlYbW3dGtlIDG7oRmDXCDk1tNAfTDHIwg1WjwEYB583Qsc7CwASrx2ZEcU7enHyX4H9kjKmfXFxX0TP6HHsOEmrFZN0U9PU_6L3Poay-UnXXSlCqLhQ7USb4GAOO_RLcpMOxZ9CvMfanGPsSY7_G2K_Orx6c8zCh_aP4nVsB-AmI5WneYfj79f9dfwENeKuo</recordid><startdate>20180701</startdate><enddate>20180701</enddate><creator>Blair, Brian M.</creator><creator>Lehman, Erik B.</creator><creator>Jafri, Syed M.</creator><creator>Kaag, Matthew G.</creator><creator>Raman, Jay D.</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20180701</creationdate><title>Predicted versus observed 30-day perioperative outcomes using the ACS NSQIP surgical risk calculator in patients undergoing partial nephrectomy for renal cell carcinoma</title><author>Blair, Brian M. ; Lehman, Erik B. ; Jafri, Syed M. ; Kaag, Matthew G. ; Raman, Jay D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-1edacd49c575a01b9f01dc3db64ca20c6b5bcbd8f3e680226b919d0b1314f6fe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Academic Medical Centers</topic><topic>Aged</topic><topic>Carcinoma, Renal Cell - mortality</topic><topic>Carcinoma, Renal Cell - pathology</topic><topic>Carcinoma, Renal Cell - surgery</topic><topic>Cohort Studies</topic><topic>Computers</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Kidney cancer</topic><topic>Kidney Neoplasms - mortality</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Laparotomy - methods</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Nephrectomy</topic><topic>Nephrectomy - adverse effects</topic><topic>Nephrectomy - methods</topic><topic>Nephrology</topic><topic>Patients</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Predictive Value of Tests</topic><topic>Preoperative Care</topic><topic>Prospective Studies</topic><topic>Renal cell carcinoma</topic><topic>Risk Assessment - methods</topic><topic>Robotic surgery</topic><topic>Robotic Surgical Procedures - methods</topic><topic>Surgical outcomes</topic><topic>Surgical site infections</topic><topic>Time Factors</topic><topic>United States</topic><topic>Urinary tract</topic><topic>Urinary tract infections</topic><topic>Urology</topic><topic>Urology - Original Paper</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Blair, Brian M.</creatorcontrib><creatorcontrib>Lehman, Erik B.</creatorcontrib><creatorcontrib>Jafri, Syed M.</creatorcontrib><creatorcontrib>Kaag, Matthew G.</creatorcontrib><creatorcontrib>Raman, Jay D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>International urology and nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Blair, Brian M.</au><au>Lehman, Erik B.</au><au>Jafri, Syed M.</au><au>Kaag, Matthew G.</au><au>Raman, Jay D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predicted versus observed 30-day perioperative outcomes using the ACS NSQIP surgical risk calculator in patients undergoing partial nephrectomy for renal cell carcinoma</atitle><jtitle>International urology and nephrology</jtitle><stitle>Int Urol Nephrol</stitle><addtitle>Int Urol Nephrol</addtitle><date>2018-07-01</date><risdate>2018</risdate><volume>50</volume><issue>7</issue><spage>1249</spage><epage>1256</epage><pages>1249-1256</pages><issn>0301-1623</issn><eissn>1573-2584</eissn><abstract><![CDATA[Purpose
The purpose of the study was to evaluate the accuracy of the American College of Surgeons NSQIP Surgical Risk Calculator for predicting risk-adjusted 30-day outcomes for patients undergoing partial nephrectomy (PN) for renal cell carcinoma (RCC).
Methods
A single institution, multi-surgeon, prospectively maintained database was queried for patients undergoing PN for RCC from 1998 to 2015. 21 preoperative factors were analyzed for each patient with predicted risk for 30-day complications, mortality, and length of stay (LOS) calculated. Differences between the mean predicted risk and observed rate of surgical outcomes were determined using two-sided one-sample
t
test with significance at
p
< 0.05. Subgroup analyses of outcomes stratified by surgical approach were also performed.
Results
470 patients undergoing PN for RCC were analyzed. Comparing NSQIP predicted to observed outcomes, clinically significant underestimations occurred with rates of overall complications (9.16 vs. 16.81%,
p
< 0.001), surgical site infections [SSI] (1.65 vs. 2.77%,
p
< 0.001), urinary tract infection [UTI] (1.41 vs. 3.40%,
p
< 0.001), and LOS (3.25 vs. 3.73 days,
p
< 0.001). On subgroup analysis, 209 open PN and 261 minimally invasive PN (MIPN) were performed. The NSQIP calculator consistently underestimated overall complications, SSI, UTI, and LOS (
p
< 0.001) among both surgical approaches, while overestimating MIPN severe complications (
p
< 0.001). Clinically important differences persisted when stratifying the MIPN group by laparoscopic (
N
= 111) and robotic (
N
= 150) approaches.
Conclusions
The ACS NSQIP Surgical Risk Calculator had significant discrepancies among observed and predicted outcomes. Additional analyses confirmed these differences remained significant irrespective of surgical approach. These findings emphasize the need for urologic oncology-specific calculators to better predict surgical outcomes in this complex patient population.]]></abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>29868938</pmid><doi>10.1007/s11255-018-1898-6</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0301-1623 |
| ispartof | International urology and nephrology, 2018-07, Vol.50 (7), p.1249-1256 |
| issn | 0301-1623 1573-2584 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2050481546 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Academic Medical Centers Aged Carcinoma, Renal Cell - mortality Carcinoma, Renal Cell - pathology Carcinoma, Renal Cell - surgery Cohort Studies Computers Databases, Factual Female Follow-Up Studies Humans Kidney cancer Kidney Neoplasms - mortality Kidney Neoplasms - pathology Kidney Neoplasms - surgery Laparoscopy Laparoscopy - methods Laparotomy - methods Length of Stay Male Medicine Medicine & Public Health Middle Aged Nephrectomy Nephrectomy - adverse effects Nephrectomy - methods Nephrology Patients Postoperative Complications - epidemiology Postoperative Complications - physiopathology Predictive Value of Tests Preoperative Care Prospective Studies Renal cell carcinoma Risk Assessment - methods Robotic surgery Robotic Surgical Procedures - methods Surgical outcomes Surgical site infections Time Factors United States Urinary tract Urinary tract infections Urology Urology - Original Paper |
| title | Predicted versus observed 30-day perioperative outcomes using the ACS NSQIP surgical risk calculator in patients undergoing partial nephrectomy for renal cell carcinoma |
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