title: Predicting Complications Following Robot-Assisted Partial Nephrectomy with the ACS NSQIP®Universal Surgical Risk Calculator.
abstract: We evaluated the predictive value of the ACS NSQIP® (American College of Surgeons National Surgical Quality Improvement Program®) surgical risk calculator in a tertiary referral cohort of patients who underwent robot-assisted partial nephrectomy.
  
  
  
  We queried our prospectively maintained, multi-institutional database of patients treated with robot-assisted partial nephrectomy and input the preoperative details of 300 randomly selected patients into the calculator. Accuracy of the calculator was assessed by the ROC AUC and the Brier score.
  
  
  
  The observed rate of any complication in our cohort was 14% while the mean predicted rate of any complication using the calculator was 5.42%. The observed rate of serious complications (Clavien score 3 or greater) was 3.67% compared to the predicted rate of 4.89%. Low AUC and high Brier score were calculated for any complication (0.51 and 0.1272) and serious complications (0.55 and 0.0352, respectively). The calculated AUC was low for all outcomes, including venous thromboembolism (0.67), surgical site infection (0.51) and pneumonia (0.44).
  
  
  
  The ACS NSQIP risk calculator poorly predicted and discriminated which patients would experience complications after robot-assisted partial nephrectomy. These findings suggest the need for a more tailored outcome prediction model to better assist urologists risk stratify patients undergoing robot-assisted partial nephrectomy and counsel them on individual surgical risks.
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
authors.forename: Jared S
authors.initials: JS
authors.lastname: Winoker
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Paulucci
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
authors.forename: Harry
authors.initials: H
authors.lastname: Anastos
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Waingankar
authors.affiliation: Robotic Urologic Surgery, OhioHealth Dublin Methodist Hospital, Columbus, Ohio.
authors.forename: Ronney
authors.initials: R
authors.lastname: Abaza
authors.affiliation: Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Eun
authors.affiliation: Division of Urology, Columbia University at Mount Sinai, Miami Beach, Florida.
authors.forename: Akshay
authors.initials: A
authors.lastname: Bhandari
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.
authors.forename: John P
authors.initials: JP
authors.lastname: Sfakianos
authors.affiliation: Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York. Electronic address: Ketan.badani@mountsinai.org.
authors.forename: Ketan K
authors.initials: KK
authors.lastname: Badani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D011446:Prospective Studies; D058996:Quality Improvement; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000379:methods
keywords: kidney; nephrectomy; postoperative complications; risk assessment; robotics