title: Accuracy of national surgery quality improvement program models in predicting postoperative morbidity in patients undergoing colectomy.
abstract: BACKGROUND
  The National Surgery Quality Improvement Program (NSQIP) is the standard for assessment of acuity-adjusted outcomes in surgery. The validity of NSQIP has not been well established in colorectal surgery. Technical and process variables, which NSQIP may not consider, affect morbidity rate.
  
  
  OBJECTIVE
  A retrospective observational study was undertaken to determine the accuracy of NSQIP models in predicting morbidity for patients undergoing laparoscopic or open colectomy.
  
  
  METHODS
  NSQIP participant use files for 2005 to 2008 were obtained. Data were selected using Current Procedural Terminology coding for open or laparoscopic colectomy. NSQIP-generated predicted morbidities were used to create area under the receiver operator curves (AUROCs).
  
  
  RESULTS
  AUROCs demonstrated an accurate predictive model if the value was above 0.8 and indicated a marginal predictor mode if below 0.7. The AUROC for the general NSQIP model was 0.817 (confidence interval [CI] = 0.815-0.819, p < 0.001). AUROC for the combined laparoscopic and open colectomy group was 0.703 (CI = 0.698-0.709, p value < 0.001). AUROCs for the individual laparoscopic and open colectomy groups were 0.627 (CI = 0.615-0.640, p < 0.001) and 0.701 (CI = 0.695-0.707, p < 0.001).
  
  
  CONCLUSIONS
  This study demonstrates that although NSQIP-generated morbidities used to create AUROCs are accurate for patients in an overall surgical model, predictive models for morbidity are marginal for laparoscopic and open abdominal colectomies. NSQIP risk models tend to emphasize comorbidities rather than intraoperative details or technical aspects of colonic resections.
authors.affiliation: Colorectal Surgeon in the Department of Surgery in the Division of Colon and Rectal Surgery at the Lee Memorial Health System in Fort Meyer, FL. Jeffneale@hotmail.com.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Neale
authors.affiliation: Colorectal Surgeon in the Division of Colon and Rectal Surgery at the Henry Ford Hospital in Detroit, MI. creicke1@hfhs.org.
authors.forename: Craig
authors.initials: C
authors.lastname: Reickert
authors.affiliation: Medical Student/Research Assistant in the Department of Surgery at the Henry Ford Hospital in Detroit, MI. answartz@med.wayne.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Swartz
authors.affiliation: General Surgery Resident in the Department of General Surgery at the Cleveland Clinic Main Campus in Cleveland, OH. sreddydr@gmail.com.
authors.forename: Subhash
authors.initials: S
authors.lastname: Reddy
authors.affiliation: Chair of the Digestive Disease Institute of Cleveland Clinic Abu Dhabi in the United Arab Emirates and an Associate Professor of Surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in OH. abbasm@clevelandclinicabudhabi.ae.
authors.forename: Maher A
authors.initials: MA
authors.lastname: Abbas
authors.affiliation: Director of the Surgical Intensive Care Units, Trauma Surgeon, and Associate Professor in the Department of Surgery in the Division of Trauma and Acute Care Surgery at the Henry Ford Hospital and the Center for Health System Research at the Henry Ford Health System in Detroit, MI. irubmd@gmail.com.
authors.forename: Ilan
authors.initials: I
authors.lastname: Rubinfeld
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods / Q000401:mortality / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000592:standards; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011785:Quality Assurance, Health Care / Q000592:standards*; D058996:Quality Improvement; D012372:ROC Curve; D012189:Retrospective Studies