Assessment of the American College of Surgeons surgical risk calculator of outcomes after hepatectomy for liver tumors: Results from a cohort of 950 patients
The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator has been endorsed to counsel patients regarding complications. The aim of this study was to assess its ability to predict outcomes after hepatectomy. Outcomes generated by the ACS-NSQIP were...
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| Veröffentlicht in: | International journal of surgery (London, England) England), 2020-12, Vol.84, p.102-108 |
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| container_title | International journal of surgery (London, England) |
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| creator | Donadon, Matteo Galvanin, Jacopo Branciforte, Bruno Palmisano, Angela Procopio, Fabio Cimino, Matteo Del Fabbro, Daniele Torzilli, Guido |
| description | The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator has been endorsed to counsel patients regarding complications. The aim of this study was to assess its ability to predict outcomes after hepatectomy.
Outcomes generated by the ACS-NSQIP were recorded in a consecutive cohort of patients. By using established classifications of complications, post-hepatectomy insufficiency and bile leak, the calculator was tested by the comparison of expected versus observed rates of events. The performance of the calculator was tested by using c-statistic and Brier score.
950 patients who underwent hepatectomy between January 2014 and June 2019 were included. Predicted rates were significantly lower than actual rates: the mean ACS-NSQIP morbidity was 17.97% ± 8.4 vs. actual 37.01% ± 0.56 (P |
| doi_str_mv | 10.1016/j.ijsu.2020.10.003 |
| format | Article |
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Outcomes generated by the ACS-NSQIP were recorded in a consecutive cohort of patients. By using established classifications of complications, post-hepatectomy insufficiency and bile leak, the calculator was tested by the comparison of expected versus observed rates of events. The performance of the calculator was tested by using c-statistic and Brier score.
950 patients who underwent hepatectomy between January 2014 and June 2019 were included. Predicted rates were significantly lower than actual rates: the mean ACS-NSQIP morbidity was 17.97% ± 8.4 vs. actual 37.01% ± 0.56 (P < 0.001); the mean ACS-NSQIP mortality was 0.91% ± 1.48 vs. actual 1.76% ± 0.11 (P < 0.001). Predicted length of stay (LOS) was significantly shorter: mean ACS-NSQIP was 5.81 ± 1.66 days vs. actual 10.91 ± 4.6 days (P < 0.001). Post-hepatectomy liver insufficiency and bile leak were recorded in 6.8% and 11.9% of patients, respectively. These events were not expressed by the calculator. C-statistic and Brier scores showed low performance of the calculator.
The calculator underestimates the risks of complications, mortality and LOS after hepatectomy. Refinements of the ACS-NSQIP model that account for organ-specific risks should be considered.
•ACS-NSQIP calculator is an important tool to counsel patients and relatives regarding postoperative complications.•ACS-NSQIP calculator has not been externally tested in patients undergoing hepatectomy for liver tumors.•ACS-NSQIP calculator underestimates the risks of complications, mortality and length of stay after hepatectomy.</description><identifier>ISSN: 1743-9191</identifier><identifier>EISSN: 1743-9159</identifier><identifier>DOI: 10.1016/j.ijsu.2020.10.003</identifier><identifier>PMID: 33099020</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>ACS-NSQIP calculator ; Adult ; Aged ; Aged, 80 and over ; Bile leak ; Cohort Studies ; Complications ; Female ; Hepatectomy ; Hepatectomy - adverse effects ; Humans ; Length of Stay ; Liver failure ; Liver Neoplasms - surgery ; Male ; Middle Aged ; Mortality ; Postoperative Complications - etiology ; Quality Improvement ; Risk Assessment - methods ; Surgeons</subject><ispartof>International journal of surgery (London, England), 2020-12, Vol.84, p.102-108</ispartof><rights>2020</rights><rights>Copyright © 2020. Published by Elsevier Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-8b20288b5c58c0e8d24b6eed0850c986f7d0f8f2cf6db857361fecf01e02a6b53</citedby><cites>FETCH-LOGICAL-c356t-8b20288b5c58c0e8d24b6eed0850c986f7d0f8f2cf6db857361fecf01e02a6b53</cites><orcidid>0000-0003-0296-7648 ; 0000-0001-5058-9827 ; 0000-0001-8202-488X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1743919120307391$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33099020$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Donadon, Matteo</creatorcontrib><creatorcontrib>Galvanin, Jacopo</creatorcontrib><creatorcontrib>Branciforte, Bruno</creatorcontrib><creatorcontrib>Palmisano, Angela</creatorcontrib><creatorcontrib>Procopio, Fabio</creatorcontrib><creatorcontrib>Cimino, Matteo</creatorcontrib><creatorcontrib>Del Fabbro, Daniele</creatorcontrib><creatorcontrib>Torzilli, Guido</creatorcontrib><title>Assessment of the American College of Surgeons surgical risk calculator of outcomes after hepatectomy for liver tumors: Results from a cohort of 950 patients</title><title>International journal of surgery (London, England)</title><addtitle>Int J Surg</addtitle><description>The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator has been endorsed to counsel patients regarding complications. The aim of this study was to assess its ability to predict outcomes after hepatectomy.
Outcomes generated by the ACS-NSQIP were recorded in a consecutive cohort of patients. By using established classifications of complications, post-hepatectomy insufficiency and bile leak, the calculator was tested by the comparison of expected versus observed rates of events. The performance of the calculator was tested by using c-statistic and Brier score.
950 patients who underwent hepatectomy between January 2014 and June 2019 were included. Predicted rates were significantly lower than actual rates: the mean ACS-NSQIP morbidity was 17.97% ± 8.4 vs. actual 37.01% ± 0.56 (P < 0.001); the mean ACS-NSQIP mortality was 0.91% ± 1.48 vs. actual 1.76% ± 0.11 (P < 0.001). Predicted length of stay (LOS) was significantly shorter: mean ACS-NSQIP was 5.81 ± 1.66 days vs. actual 10.91 ± 4.6 days (P < 0.001). Post-hepatectomy liver insufficiency and bile leak were recorded in 6.8% and 11.9% of patients, respectively. These events were not expressed by the calculator. C-statistic and Brier scores showed low performance of the calculator.
The calculator underestimates the risks of complications, mortality and LOS after hepatectomy. Refinements of the ACS-NSQIP model that account for organ-specific risks should be considered.
•ACS-NSQIP calculator is an important tool to counsel patients and relatives regarding postoperative complications.•ACS-NSQIP calculator has not been externally tested in patients undergoing hepatectomy for liver tumors.•ACS-NSQIP calculator underestimates the risks of complications, mortality and length of stay after hepatectomy.</description><subject>ACS-NSQIP calculator</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bile leak</subject><subject>Cohort Studies</subject><subject>Complications</subject><subject>Female</subject><subject>Hepatectomy</subject><subject>Hepatectomy - adverse effects</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Liver failure</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Postoperative Complications - etiology</subject><subject>Quality Improvement</subject><subject>Risk Assessment - methods</subject><subject>Surgeons</subject><issn>1743-9191</issn><issn>1743-9159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UcuOEzEQtBCIXRZ-gAPykUtCe2Y88SAuUcRLWgmJx9nyeNobBzsObs9K-zH8Kx6y7JGTS-WqVncVYy8FrAWI_s1h7Q80rxtoFmIN0D5il2LTtatByOHxAx7EBXtGdADoQAn1lF20LQxDtV2y31siJIp4LDw5XvbItxGzt-bIdykEvMGF_zbnG0xH4lRB_Qw8e_rJK7BzMCXlRZTmYlNE4sYVzHyPJ1PQlhTvuKuK4G8rW-aYMr3lX5HmUIi7nCI33KZ9yn9XGCTwavR1I3rOnjgTCF_cv1fsx4f333efVtdfPn7eba9XtpV9WamxZqDUKK1UFlBNTTf2iBMoCXZQvdtM4JRrrOunUclN2wuH1oFAaEw_yvaKvT7PPeX0a0YqOnqyGII5YppJN53sBMi2E1XanKU2J6KMTp-yjybfaQF6qUUf9FKLXmpZuFpLNb26nz-PEacHy78equDdWYD1yluPWZOtCVicfK4R6in5_83_A7XUoYQ</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Donadon, Matteo</creator><creator>Galvanin, Jacopo</creator><creator>Branciforte, Bruno</creator><creator>Palmisano, Angela</creator><creator>Procopio, Fabio</creator><creator>Cimino, Matteo</creator><creator>Del Fabbro, Daniele</creator><creator>Torzilli, Guido</creator><general>Elsevier Ltd</general><scope>6I.</scope><scope>AAFTH</scope><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>7X8</scope><orcidid>https://orcid.org/0000-0003-0296-7648</orcidid><orcidid>https://orcid.org/0000-0001-5058-9827</orcidid><orcidid>https://orcid.org/0000-0001-8202-488X</orcidid></search><sort><creationdate>202012</creationdate><title>Assessment of the American College of Surgeons surgical risk calculator of outcomes after hepatectomy for liver tumors: Results from a cohort of 950 patients</title><author>Donadon, Matteo ; Galvanin, Jacopo ; Branciforte, Bruno ; Palmisano, Angela ; Procopio, Fabio ; Cimino, Matteo ; Del Fabbro, Daniele ; Torzilli, Guido</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-8b20288b5c58c0e8d24b6eed0850c986f7d0f8f2cf6db857361fecf01e02a6b53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>ACS-NSQIP calculator</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bile leak</topic><topic>Cohort Studies</topic><topic>Complications</topic><topic>Female</topic><topic>Hepatectomy</topic><topic>Hepatectomy - adverse effects</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Liver failure</topic><topic>Liver Neoplasms - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Postoperative Complications - etiology</topic><topic>Quality Improvement</topic><topic>Risk Assessment - methods</topic><topic>Surgeons</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Donadon, Matteo</creatorcontrib><creatorcontrib>Galvanin, Jacopo</creatorcontrib><creatorcontrib>Branciforte, Bruno</creatorcontrib><creatorcontrib>Palmisano, Angela</creatorcontrib><creatorcontrib>Procopio, Fabio</creatorcontrib><creatorcontrib>Cimino, Matteo</creatorcontrib><creatorcontrib>Del Fabbro, Daniele</creatorcontrib><creatorcontrib>Torzilli, Guido</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of surgery (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Donadon, Matteo</au><au>Galvanin, Jacopo</au><au>Branciforte, Bruno</au><au>Palmisano, Angela</au><au>Procopio, Fabio</au><au>Cimino, Matteo</au><au>Del Fabbro, Daniele</au><au>Torzilli, Guido</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of the American College of Surgeons surgical risk calculator of outcomes after hepatectomy for liver tumors: Results from a cohort of 950 patients</atitle><jtitle>International journal of surgery (London, England)</jtitle><addtitle>Int J Surg</addtitle><date>2020-12</date><risdate>2020</risdate><volume>84</volume><spage>102</spage><epage>108</epage><pages>102-108</pages><issn>1743-9191</issn><eissn>1743-9159</eissn><abstract>The American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) calculator has been endorsed to counsel patients regarding complications. The aim of this study was to assess its ability to predict outcomes after hepatectomy.
Outcomes generated by the ACS-NSQIP were recorded in a consecutive cohort of patients. By using established classifications of complications, post-hepatectomy insufficiency and bile leak, the calculator was tested by the comparison of expected versus observed rates of events. The performance of the calculator was tested by using c-statistic and Brier score.
950 patients who underwent hepatectomy between January 2014 and June 2019 were included. Predicted rates were significantly lower than actual rates: the mean ACS-NSQIP morbidity was 17.97% ± 8.4 vs. actual 37.01% ± 0.56 (P < 0.001); the mean ACS-NSQIP mortality was 0.91% ± 1.48 vs. actual 1.76% ± 0.11 (P < 0.001). Predicted length of stay (LOS) was significantly shorter: mean ACS-NSQIP was 5.81 ± 1.66 days vs. actual 10.91 ± 4.6 days (P < 0.001). Post-hepatectomy liver insufficiency and bile leak were recorded in 6.8% and 11.9% of patients, respectively. These events were not expressed by the calculator. C-statistic and Brier scores showed low performance of the calculator.
The calculator underestimates the risks of complications, mortality and LOS after hepatectomy. Refinements of the ACS-NSQIP model that account for organ-specific risks should be considered.
•ACS-NSQIP calculator is an important tool to counsel patients and relatives regarding postoperative complications.•ACS-NSQIP calculator has not been externally tested in patients undergoing hepatectomy for liver tumors.•ACS-NSQIP calculator underestimates the risks of complications, mortality and length of stay after hepatectomy.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>33099020</pmid><doi>10.1016/j.ijsu.2020.10.003</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-0296-7648</orcidid><orcidid>https://orcid.org/0000-0001-5058-9827</orcidid><orcidid>https://orcid.org/0000-0001-8202-488X</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1743-9191 |
| ispartof | International journal of surgery (London, England), 2020-12, Vol.84, p.102-108 |
| issn | 1743-9191 1743-9159 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | ACS-NSQIP calculator Adult Aged Aged, 80 and over Bile leak Cohort Studies Complications Female Hepatectomy Hepatectomy - adverse effects Humans Length of Stay Liver failure Liver Neoplasms - surgery Male Middle Aged Mortality Postoperative Complications - etiology Quality Improvement Risk Assessment - methods Surgeons |
| title | Assessment of the American College of Surgeons surgical risk calculator of outcomes after hepatectomy for liver tumors: Results from a cohort of 950 patients |
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