title: Can the ACS-NSQIP surgical risk calculator predict post-operative complications in patients undergoing flap reconstruction following soft tissue sarcoma resection?
abstract: BACKGROUND
  The ACS-NSQIP surgical risk calculator is an open-access on-line tool that estimates the risk of adverse post-operative outcomes for a wide range of surgical procedures. Wide surgical resection of soft tissue sarcoma (STS) often requires complex reconstructive procedures that can be associated with relatively high rates of complications. This study evaluates the ability of this calculator to identify patients with STS at risk for post-operative complications following flap reconstruction.
  
  
  METHODS
  Clinical details of 265 patients who underwent flap reconstruction following STS resection were entered into the online calculator. The predicted rates of complications were compared to the observed rates. The calculator model was validated using measures of prediction and discrimination.
  
  
  RESULTS
  The mean predicted rate of any complication was 15.35 ± 5.6% which differed significantly from the observed rate of 32.5% (P = 0.009). The c-statistic was relatively low at 0.626 indicating poor discrimination between patients who are at risk of complications and those who are not. The Brier's score of 0.242 was significantly different from 0 (P < 0.001) indicating poor correlation between the predicted and actual probability of complications.
  
  
  CONCLUSIONS
  The ACS-NSQIP universal risk calculator did not maintain its predictive value in patients undergoing flap reconstruction following STS resection. J. Surg. Oncol. 2016;114:570-575. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University of Toronto, Toronto, Canada.|University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Jelena
authors.initials: J
authors.lastname: Slump
authors.affiliation: University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.|University Musculoskeletal Oncology Unit, Department of Surgical Oncology, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ferguson
authors.affiliation: University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.|University Musculoskeletal Oncology Unit, Department of Surgical Oncology, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Jay S
authors.initials: JS
authors.lastname: Wunder
authors.affiliation: University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.|University Musculoskeletal Oncology Unit, Department of Surgical Oncology, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Griffin
authors.affiliation: University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University of Toronto, Toronto, Canada.|University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Shaghayegh
authors.initials: S
authors.lastname: Bagher
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University of Toronto, Toronto, Canada.|University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University of Toronto, Toronto, Canada.|University Health Network, Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Stefan O P
authors.initials: SO
authors.lastname: Hofer
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgical Oncology, University of Toronto, Toronto, Canada. Anne.O'Neill@uhn.ca.|University Health Network, Department of Surgery, University of Toronto, Toronto, Canada. Anne.O'Neill@uhn.ca.
authors.forename: Anne C
authors.initials: AC
authors.lastname: O'Neill
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D019651:Plastic Surgery Procedures / Q000009:adverse effects*; D018570:Risk Assessment; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*; D013524:Surgical Flaps / Q000009:adverse effects*
keywords: flap reconstruction; risk calculation; soft tissue sarcoma