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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8618691/ https://www.ncbi.nlm.nih.gov/pubmed/34830708 http://dx.doi.org/10.3390/jcm10225426 |
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author | Hers, Tessa M. Van Schaik, Jan Keekstra, Niels Putter, Hein Hamming, Jaap F. Van Der Vorst, Joost R. |
author_facet | Hers, Tessa M. Van Schaik, Jan Keekstra, Niels Putter, Hein Hamming, Jaap F. Van Der Vorst, Joost R. |
author_sort | Hers, Tessa M. |
collection | PubMed |
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 | Online Article Text |
id | pubmed-8618691 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-86186912021-11-27 Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery Hers, Tessa M. Van Schaik, Jan Keekstra, Niels Putter, Hein Hamming, Jaap F. Van Der Vorst, Joost R. J Clin Med Article 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. MDPI 2021-11-20 /pmc/articles/PMC8618691/ /pubmed/34830708 http://dx.doi.org/10.3390/jcm10225426 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Hers, Tessa M. Van Schaik, Jan Keekstra, Niels Putter, Hein Hamming, Jaap F. Van Der Vorst, Joost R. Inaccurate Risk Assessment by the ACS NSQIP Risk Calculator in Aortic Surgery |
title | 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_short | 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 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8618691/ https://www.ncbi.nlm.nih.gov/pubmed/34830708 http://dx.doi.org/10.3390/jcm10225426 |
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