title: Evaluation of the performance of the ACS NSQIP surgical risk calculator in gynecologic oncology patients undergoing laparotomy.
abstract: The objective of this study was to evaluate the ability of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator to predict complications in gynecologic oncology patients undergoing laparotomy.
  
  
  
  A chart review of patients who underwent laparotomy on the gynecologic oncology service at a single academic hospital from January 2009 to December 2013 was performed. Preoperative variables were abstracted and NSQIP surgical risk scores were calculated. The risk of any complication, serious complication, death, urinary tract infection, venous thromboembolism, cardiac event, renal complication, pneumonia and surgical site infection were correlated with actual patient outcomes using logistic regression. The c-statistic and Brier score were used to calculate the prediction capability of the risk calculator.
  
  
  
  Of the 1094 patients reviewed, the majority were <65years old (70.9%), independent (95.2%), ASA class 1-2 (67.3%), and overweight or obese (76.1%). Higher calculated risk scores were associated with an increased risk of the actual complication occurring for all events (p<0.05). The calculator performed best for predicting death (c-statistic=0.851, Brier=0.008), renal failure (c-statistic=0.752, Brier=0.015) and cardiac complications (c-statistic=0.708, Brier=0.011). The calculator did not accurately predict most complications.
  
  
  
  The NSQIP surgical risk calculator adequately predicts specific serious complications, such as postoperative death and cardiac complications. However, the overall performance of the calculator was worse for gynecologic oncology patients than reported in general surgery patients. A tailored prediction model may be needed for this patient population.
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Colleen
authors.initials: C
authors.lastname: Rivard
authors.affiliation: Medical School, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Rebi
authors.initials: R
authors.lastname: Nahum
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Slagle
authors.affiliation: Medical School, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Megan
authors.initials: M
authors.lastname: Duininck
authors.affiliation: Biostatistics and Bioinformatics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States.
authors.forename: Rachel
authors.initials: R
authors.lastname: Isaksson Vogel
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, United States. Electronic address: dkteoh@umn.edu.
authors.forename: Deanna
authors.initials: D
authors.lastname: Teoh
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment / Q000379:methods*
keywords: Laparotomy; NSQIP; Postoperative complications; Surgical Risk