A. L. Lubitz1, E. Chan1, D. Zarif1, M. Philp1, H. Ross1, A. Goldberg1, H. Pitt1 1Temple University,Philadelpha, PA, USA
Introduction: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) has developed a Risk Calculator to assist patients and surgeons with difficult shared operative decisions. However, limited data are available to validate the Risk Calculator in elective surgery, and studies to evaluate its utility in emergent situations are not available. The aim of this analysis was to determine the accuracy of the ACS-NSQIP Risk Calculator in patients undergoing elective and emergent colorectal operations.
Methods: From January 2013 through December 2015, 75 patients undergoing emergent colorectal surgery at a safety-net hospital were identified. These patients were matched with 75 patients having elective colorectal operations within four days before or after the urgent cases. Charts were reviewed to obtain preoperative risk factors to populate the Risk Calculator (RC). Actual postoperative outcomes, derived from National Surgical Quality Improvement (NSQIP) data, were compared to those predicted by the RC. Serious complications were defined as previously described within NSQIP. Student’s t-tests were used to compare means for categorical variables and Chi-Squared test for goodness of fit were used to analyze ordinal variables. Statistical analyses were performed with SPSS version 22.
Results: Emergent and elective patients differed (p<0.01) with respect to age, functional status, ASA class, steroid use, wound class, chronic obstructive pulmonary disease and chronic renal insufficiency. The RC accurately predicted outcomes in elective patients. Outcomes were worse in the emergent than in the elective operations (Table). In emergent cases the RC underestimated serious complications (Comp) and length of stay (LOS) and overestimated discharge to a Skilled Nursing Facility (SNF) (Table).
Conclusions: The ACS-NSQIP Risk Calculator accurately predicts outcomes for elective colorectal surgery. Predicted and actual outcomes are dramatically increased in patients undergoing emergent colon operations. In patients requiring emergent colectomy the Risk Calculator underestimates serious complications and length of stay and overestimates the ability of safety-net patients to be discharged to a Skilled Nursing Facility.
