title: Evaluation of the National Surgical Quality Improvement Program Universal Surgical Risk Calculator for a gynecologic oncology service.
abstract: OBJECTIVE
  The National Surgical Quality Improvement Program is aimed at preventing perioperative complications. An online calculator was recently published, but the primary studies used limited gynecologic surgery data. The purpose of this study was to evaluate the performance of the National Surgical Quality Improvement Program Universal Surgical Risk Calculator (URC) on the patients of a gynecologic oncology service.
  
  
  METHODS
  We reviewed 628 consecutive surgeries performed by our gynecologic oncology service between July 2012 and June 2013. Demographic data including diagnosis and cancer stage, if applicable, were collected. Charts were reviewed to determine complication rates. Specific complications were as follows: death, pneumonia, cardiac complications, surgical site infection (SSI) or urinary tract infection, renal failure, or venous thromboembolic event. Data were compared with modeled outcomes using Brier scores and receiver operating characteristic curves. Significance was declared based on P < 0.05.
  
  
  RESULTS
  The model accurately predicated death and venous thromboembolic event, with Brier scores of 0.004 and 0.003, respectively. Predicted risk was 50% greater than experienced for urinary tract infection; the experienced SSI and pneumonia rates were 43% and 36% greater than predicted. For any complication, the Brier score 0.023 indicates poor performance of the model.
  
  
  CONCLUSIONS
  In this study of gynecologic surgeries, we could not verify the predictive value of the URC for cardiac complications, SSI, and pneumonia. One disadvantage of applying a URC to multiple subspecialties is that with some categories, complications are not accurately estimated. Our data demonstrate that some predicted risks reported by the calculator need to be interpreted with reservation.
authors: *Division of Gynecologic Oncology, Department of Surgery, and †Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY.
authors: J Brian
authors: JB
authors: Szender
authors: Peter J
authors: PJ
authors: Frederick
authors: Kevin H
authors: KH
authors: Eng
authors: Stacey N
authors: SN
authors: Akers
authors: Shashikant B
authors: SB
authors: Lele
authors: Kunle
authors: K
authors: Odunsi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D006176:Gynecology / Q000592:standards*; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D016522:Oncology Service, Hospital / Q000592:standards*; D011014:Pneumonia / Q000209:etiology; D058996:Quality Improvement; D012372:ROC Curve; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013530:Surgical Wound Infection / Q000209:etiology; D014552:Urinary Tract Infections / Q000209:etiology; D054556:Venous Thromboembolism / Q000209:etiology
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