title: The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Does Not Accurately Predict Risk of 30-Day Complications Among Patients Undergoing Microvascular Head and Neck Reconstruction.
abstract: OBJECTIVE
  The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator (SRC) is a novel universal risk calculator designed to aid in risk stratification of patients undergoing various types of major surgery. The purpose of this study was to assess the validity of the ACS NSQIP SRC in predicting postoperative complications in patients undergoing microvascular head and neck reconstruction.
  
  
  METHODS
  A retrospective cohort study of patients undergoing head and neck microvascular reconstruction with fibular free flaps at a single institution was completed. The NSQIP SRC was used to compute complication risk estimates and length of stay (LOS) estimates for all patients under study. Associations between complication risk estimates generated by the SRC and actual rates of observed complications were evaluated using logistic regression models. Logistic regression models also were used to evaluate the SRC estimates for LOS duration compared with the actual observed LOS after surgery.
  
  
  RESULTS
  Of 153 patients under study, 46 (30%) developed a postoperative complication corresponding to those defined by NSQIP SRC. Thirty-eight patients (25%) developed a postoperative complication categorized as severe in the parameters of the NSQIP SRC. None of the SRC complication estimates showed a statistically relevant association with the corresponding observed rates of complications. The mean LOS predicted by the SRC was 8.0 days (median, 7.5 days; interquartile range [IQR], 6.5 to 9; range, 5.0 to 18.5 days). The mean observed LOS for the study group was 9.6 days (median, 7.0 days; IQR, 6 to 9; range, 5 to 67 days). Lin's (Biometrics 45:255, 1989) concordance correlation coefficient to measure agreement between observed and predicted LOS was 0.10, indicating only slight agreement between the 2 values.
  
  
  CONCLUSIONS
  The ACS NSQIP SRC is not a useful risk-stratifying metric for patients undergoing major head and neck reconstruction with microvascular fibular free flaps. The SRC also does not accurately predict hospital LOS for this same patient cohort.
authors.affiliation: Assistant Professor and Program Director, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN. Electronic address: arcek1@gmail.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: Arce
authors.affiliation: Professor, Division of Head and Neck Surgery, Department of Otorhinolaryngology, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Moore
authors.affiliation: Biostatistician, Division of Biostatistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Lohse
authors.affiliation: Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Reiland
authors.affiliation: Instructor, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Yetzer
authors.affiliation: Chief Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic and Mayo College of Medicine, Rochester, MN.
authors.forename: Kyle S
authors.initials: KS
authors.lastname: Ettinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005360:Fibula / Q000098:blood supply / Q000637:transplantation; D006257:Head / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D058996:Quality Improvement; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012955:Societies, Medical; D013524:Surgical Flaps / Q000098:blood supply; D014481:United States / Q000453:epidemiology