Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery

Objectives: The aim of this retrospective study was to assess the predictive performance of the American College of Surgeons (ACS) risk calculator for aortic aneurysm repair for the patient population of a Dutch tertiary referral hospital. Methods: This retrospective study included all patients who...

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Autores principales:	Tessa M. Hers, Jan Van Schaik, Niels Keekstra, Hein Putter, Jaap F. Hamming, Joost R. Van Der Vorst
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	risk assessment risk prediction model ACS NSQIP risk calculator vascular surgery Medicine R
Acceso en línea:	https://doaj.org/article/1765ce4bb7464b09bcbdf7f8e9bccc0c
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spelling	oai:doaj.org-article:1765ce4bb7464b09bcbdf7f8e9bccc0c2021-11-25T18:02:41ZInaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery10.3390/jcm102254262077-0383https://doaj.org/article/1765ce4bb7464b09bcbdf7f8e9bccc0c2021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5426https://doaj.org/toc/2077-0383Objectives: The aim of this retrospective study was to assess the predictive performance of the American College of Surgeons (ACS) risk calculator for aortic aneurysm repair for the patient population of a Dutch tertiary referral hospital. Methods: This retrospective study included all patients who underwent elective endovascular or open aortic aneurysm repair at our institution between the years 2013 and 2019. Preoperative patient demographics and postoperative complication data were collected, and individual risk assessments were generated using five different current procedural terminology (CPT) codes. Receiver operating characteristic (ROC) curves, calibration plots, Brier scores, and Index of Prediction Accuracy (IPA) values were generated to evaluate the predictive performance of the ACS risk calculator in terms of discrimination and calibration. Results: Two hundred thirty-four patients who underwent elective endovascular or open aortic aneurysm repair were identified. Only five out of thirteen risk predictions were found to be sufficiently discriminative. Furthermore, the ACS risk calculator showed a structurally insufficient calibration. Most Brier scores were close to 0; however, comparison to a null model though IPA-scores showed the predictions generated by the ACS risk calculator to be inaccurate. Overall, the ACS risk calculator showed a consistent underestimation of the risk of complications. Conclusions: The ACS risk calculator proved to be inaccurate within the framework of endovascular and open aortic aneurysm repair in our medical center. To minimize the effects of patient selection and cultural differences, multicenter collaboration is necessary to assess the performance of the ACS risk calculator in aortic surgery.Tessa M. HersJan Van SchaikNiels KeekstraHein PutterJaap F. HammingJoost R. Van Der VorstMDPI AGarticlerisk assessmentrisk prediction modelACS NSQIP risk calculatorvascular surgeryMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5426, p 5426 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	risk assessment risk prediction model ACS NSQIP risk calculator vascular surgery Medicine R
spellingShingle	risk assessment risk prediction model ACS NSQIP risk calculator vascular surgery Medicine R Tessa M. Hers Jan Van Schaik Niels Keekstra Hein Putter Jaap F. Hamming Joost R. Van Der Vorst Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery
description	Objectives: The aim of this retrospective study was to assess the predictive performance of the American College of Surgeons (ACS) risk calculator for aortic aneurysm repair for the patient population of a Dutch tertiary referral hospital. Methods: This retrospective study included all patients who underwent elective endovascular or open aortic aneurysm repair at our institution between the years 2013 and 2019. Preoperative patient demographics and postoperative complication data were collected, and individual risk assessments were generated using five different current procedural terminology (CPT) codes. Receiver operating characteristic (ROC) curves, calibration plots, Brier scores, and Index of Prediction Accuracy (IPA) values were generated to evaluate the predictive performance of the ACS risk calculator in terms of discrimination and calibration. Results: Two hundred thirty-four patients who underwent elective endovascular or open aortic aneurysm repair were identified. Only five out of thirteen risk predictions were found to be sufficiently discriminative. Furthermore, the ACS risk calculator showed a structurally insufficient calibration. Most Brier scores were close to 0; however, comparison to a null model though IPA-scores showed the predictions generated by the ACS risk calculator to be inaccurate. Overall, the ACS risk calculator showed a consistent underestimation of the risk of complications. Conclusions: The ACS risk calculator proved to be inaccurate within the framework of endovascular and open aortic aneurysm repair in our medical center. To minimize the effects of patient selection and cultural differences, multicenter collaboration is necessary to assess the performance of the ACS risk calculator in aortic surgery.
format	article
author	Tessa M. Hers Jan Van Schaik Niels Keekstra Hein Putter Jaap F. Hamming Joost R. Van Der Vorst
author_facet	Tessa M. Hers Jan Van Schaik Niels Keekstra Hein Putter Jaap F. Hamming Joost R. Van Der Vorst
author_sort	Tessa M. Hers
title	Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery
title_short	Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery
title_full	Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery
title_fullStr	Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery
title_full_unstemmed	Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery
title_sort	inaccurate risk assessment by the acs nsqip risk calculator in aortic surgery
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/1765ce4bb7464b09bcbdf7f8e9bccc0c
work_keys_str_mv	AT tessamhers inaccurateriskassessmentbytheacsnsqipriskcalculatorinaorticsurgery AT janvanschaik inaccurateriskassessmentbytheacsnsqipriskcalculatorinaorticsurgery AT nielskeekstra inaccurateriskassessmentbytheacsnsqipriskcalculatorinaorticsurgery AT heinputter inaccurateriskassessmentbytheacsnsqipriskcalculatorinaorticsurgery AT jaapfhamming inaccurateriskassessmentbytheacsnsqipriskcalculatorinaorticsurgery AT joostrvandervorst inaccurateriskassessmentbytheacsnsqipriskcalculatorinaorticsurgery
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Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery

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