Abstract
Compare the ACS-NSQIP risk calculator with institutional risk for colorectal surgery.
Actual and predicted outcomes were compared for both cohort and individuals.
For the cohort, the risk calculator was accurate for 7/8 outcomes; there were more serious complications than predicted (19.4 vs 14.7%, p < 0.05). Risk calculator Brier scores and null Brier scores were comparable.
with better outcomes than predicted were current smokers (OR 4.3 95% CI 1.2–15.4), ASA ≥ 3 (OR 10.4, 95% CI 2.8–39.2), underwent total/subtotal colectomy (OR 3.5, 95% CI 1.1–12.2) or operated by Surgeon 2 (OR 2.9, 95% CI 1.4–11.6). Patients with serious complications who had low predicted risk had low ASA (OR 10.5, 95% CI 1.3–82.6), and underwent operation by Surgeon 2 (OR 11.8, 95% CI 2.5, 55.2).
Single center study, sample size may bias subgroup analyses.
The ACS NSQIP calculator did not predict outcome better than sample risk.
•The calculator underpredicts “serious complication” following colorectal surgery.•The calculator did not perform better than simply assigning patients cohort risk.•The calculator predicted risk better for some surgeons than for others.•It is harder to predict poor outcomes in lower risk patients.
The ACS-NSQIP risk predictions were calculated for patients undergoing colorectal surgery. The calculator underpredicted serious complication and did not predict outcomes better than simply assigning each patient the population risk.