title: Does one score fit all? Measuring risk in ulcerative colitis.
abstract: BACKGROUND
  The American College of Surgeons Surgical Risk Calculator was developed to improve risk stratification and surgical quality but has not been studied at the institutional level for specific disease states, like ulcerative colitis (UC).
  
  
  METHODS
  UC patients undergoing colorectal resection had predicted risk calculator data compared with actual outcomes for length of stay (LOS), complications, reoperation, and death. Main outcome measures were the difference in actual vs predicted outcomes.
  
  
  RESULTS
  Seventy patients were evaluated. The actual and predicted mean LOS was identical, but not representative of the actual LOS picture, which had 10 LOS outliers (14.3%). The actual incidence of any complication (P < .001) and major complications (P < .001) was higher than predicted. The most common complications actually encountered-intrabdominal abscess (14.3%), postoperative ileus (7.2%), and anastomotic leak (5.7%), were not even calculated by the tool.
  
  
  CONCLUSIONS
  For UC, the calculator poorly evaluates relevant risks, complications, and is greatly impacted by outliers. These limitations caution use for surgical quality reporting and determining specific patient outcomes, at least in UC.
authors.affiliation: Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA; Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, TX 77030, USA. Electronic address: debby_keller@hotmail.com.
authors.forename: Deborah S
authors.initials: DS
authors.lastname: Keller
authors.affiliation: Division of Colorectal Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
authors.forename: Kyle G
authors.initials: KG
authors.lastname: Cologne
authors.affiliation: Department of Surgery, University Hospitals-Parma Medical Center, Parma, OH, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Senagore
authors.affiliation: Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA; Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, TX 77030, USA; Minimally Invasive Colon and Rectal Surgery, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Haas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003082:Colectomy / Q000009:adverse effects*; D003093:Colitis, Ulcerative / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: ACS Surgical Risk Calculator; Inflammatory bowel disease; Laparoscopic colorectal surgery; NSQIP; Patient outcomes; Quality measures