C. J. Parkin1,2, P. Moritz1,2, A. Glover1,2 1Royal North Shore Hospital,Department Of Surgery & Surgical Education Research And Training (SERT) Institute,Sydney, NSW, Australia 2University Of Sydney,Northern Clinical School, Faculty Of Medicine And Health,Sydney, NSW, Australia
Introduction:
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator provides an estimation of 30-day post-operative complications including mortality. This tool has the potential to both aid in decision-making for patients and their families, but also aid in optimising management of high-risk patients. Whilst validated within the American surgical population, its utility internationally in patients requiring emergency surgery is not yet known. This study undertook a systematic review and meta-analysis to assess the calculator’s accuracy in predicting mortality in emergency surgery patients. According to the literature, this is one of first studies to perform a meta-analysis assessing the performance of the ACS-NSQIP calculator in an external patient cohort outside of the ACS-NSQIP database.
Methods:
A comprehensive literature search was conducted between October 2019 to April 2020. The PubMed, Medline and Cochrane Databases were searched for relevant studies. The search strategy included studies from January 2013 to April 2020. There were no language restrictions placed. Reference lists of retrieved articles from these databases were used to identify further studies eligible for inclusion. Two independent reviewers screened a total of 402 records. 66 full-text articles were assessed for eligibility. Six studies were included in our final meta-analysis. A random effects model was used and fitted using restricted maximum likelihood estimation (REML). The O/E ratio was used to validate the calculator’s accuracy in predicting mortality. Heterogeneity was analysed using the I2 and Cochrane Q tests.
Results:
Six studies were included in the meta-analysis, with a total of 1835 patients undergoing emergency surgery. The summary estimate of the O:E ratio of the ACS-NSQIP surgical risk calculator in predicting 30-day post-operative mortality was 1.06 (95% CI 0.74-1.51). As expected there was significant heterogeneity between studies with a Cochrane Q of 11.96 (p = 0.04) and I2 = 57.5%. The forest plot analysis outlines the findings of the meta-analysis.
Conclusion:
This meta-analysis has showed that that the calculator does have potential to be utilised in the multi-disciplinary care of patients undergoing emergency surgery. As the ACS-NSQIP surgical risk calculator is still reasonably new, there remains limited studies published in the literature attempting to externally validate its performance, accounting for this study's heterogeneity. As further studies publish their local results, further studies will be able to further delineate its true accuracy in international surgical cohorts
