Is the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator applicable for breast cancer patients undergoing breast-conserving surgery?
BACKGROUND
We aimed to analyze the applicability of the National Surgical Quality Improvement Program (NSQIP) calculator to patients undergoing breast-conserving surgery.


METHODS
A total of 287 consecutive patients treated with breast-conserving surgery from 2010 to 2012 were identified retrospectively. The risk calculator was applied to each patient to generate an individual risk profile. Risk calculations were then compared with actual outcomes. The performance of the risk calculator was evaluated using 2 metrics: the Brier score and c statistic.


RESULTS
The NSQIP calculator performed adequately for all complications, with Brier scores less than .05. However, 37 patients (12.9%) returned to the operating room for oncologic indications. Twenty-nine patients (10.1%) had positive margins, whereas 8 patients (2.8%) returned due to an upgrade in diagnosis.


CONCLUSIONS
When considering return to the operating room for oncologic management, the observed rate of 13.9% is significantly higher than the NSQIP prediction. This deviation must be addressed when using the NSQIP risk calculator model during preoperative risk discussion.
Department of Surgery, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA; Department of Medical Education, Gundersen Medical Foundation, La Crosse, WI, USA.
Brian
B
Lyle
Department of Surgery, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA; Norma J. Vinger Center for Breast Care, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA.
Jeffrey
J
Landercasper
Department of Surgery, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA; Norma J. Vinger Center for Breast Care, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA.
Jeanne M
JM
Johnson
Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA.
Mohammed
M
Al-Hamadani
Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA.
Choua A
CA
Vang
Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA.
Jacqueline
J
Groshek
Norma J. Vinger Center for Breast Care, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA.
Joy L
JL
Hennessy
Norma J. Vinger Center for Breast Care, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA.
Lonna M
LM
Theede
Department of Medical Research, Gundersen Medical Foundation, La Crosse, WI, USA.
Kristin
K
Zutavern
Department of Surgery, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA; Norma J. Vinger Center for Breast Care, Gundersen Health System, 1900 South Avenue, La Crosse, WI, 54601, USA. Electronic address: jhlineba@gundersenhealth.org.
Jared H
JH
Linebarger
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States
Breast-conserving surgery; Lumpectomy; Morbidity; NSQIP risk calculator; Quality improvement