Postoperative Complications Clinical Trial
Official title:
Evaluation of the ACS-NSQIP Risk Calculator for Emergent Surgery in a Spanish Population
Nowadays, quality of life and individualised medicine are becoming more important in the
everyday medical practice and surgery it is not an exception. In recent years, the interest
in the improvement of the quality of surgical procedures and outcomes has increased. This
quality can be improved by assessing the surgical or operative risk by evaluating the
postoperative mortality and morbidity.
Most of the risk stratification tools are used in elective surgery. Only few have been
specifically validated for immediate or urgent. However, there are different situations. In
elective interventions, the patient and the surgeon can discuss the advantages and drawbacks
and postpone the decision. Moreover, an improvement in the physical status of the patient can
be performed whereas in immediate or urgent surgery there is no time to neither of them.
POSSUM is used as the main tool for the prediction of mortality and morbidity and for
assessing the quality care of the General Surgery Unit of Corporació Sanitària Parc Taulí.
Nevertheless, this system has its limitations. It overestimates mortality in low risk
patients and it does not take into account the specific surgical procedure.
That is why, it is believed that the ACS-NSQIP risk calculator -created in 2013- is a
potential good tool to stratify surgical risks. In contrast with POSSUM, it considers any
surgical procedure -according to the Current Procedural Terminology.
The calculator has been externally validated in population of North-America which requires
emergent surgery with a somewhat underestimation of the risk. As populations have different
profiles and there are different levels of care, it is needed the external validation in
other countries.
In essence, there is a need of validation of risk calculators in different populations and
emergency surgery (immediate and urgent) is distinct from the elective operation, therefore
they should be considered separately when risk is calculated.
Therefore, there is a need of validation of the ACS NSQIP risk calculator in Spanish
population which requires emergency (immediate and urgent) surgery. On the other hand, it is
suggested that ACS NSQIP risk calculator performs better than POSSUM . Hence, its prediction
performance is compared with POSSUM.
A prospective validation cohort study is proposed. The surgical risk of the patients
recruited in the study was calculated by the ACS NSQIP risk calculator and by POSSUM.
In order to compare the performance of ACS NSQIP risk calculator with POSSUM, area under the
receiver operating characteristic curve (AUC) was calculated for each tool. The statistical
differences between the two AUC curves were compared using P value. Calibration of the
agreement between observed and predicted outcomes was tested using the Brier score. The Brier
score ranges from 0 to 1. The closer the score is to 0, the more accurate is the risk
prediction model.
There is a need of validation of the ACS NSQIP risk calculator in Spanish population which
requires emergency (immediate and urgent) surgery. Besides, it is suggested that ACS NSQIP
risk calculator performs better than POSSUM. Hence, its prediction performance is compared
with POSSUM.
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