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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...

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Autores principales: Hers, Tessa M., Van Schaik, Jan, Keekstra, Niels, Putter, Hein, Hamming, Jaap F., Van Der Vorst, Joost R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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