American College of Surgeons NSQIP Risk Calculator Accuracy for Emergent and Elective Colorectal Operations

Background The American College of Surgeons NSQIP has developed a risk calculator (RC) to assist patients and surgeons with difficult decisions. The aim of this analysis was to determine the accuracy of the RC in patients undergoing elective and emergent colorectal operations. Study Design From January 2013 through December 2015, seventy-five patients undergoing emergent colorectal operations were paired by date with 75 patients having elective colorectal operations. Patient data were entered into the RC. Actual postoperative outcomes, derived from NSQIP data, were compared with those predicted by the RC. Results Emergent and elective patients differed (p < 0.05) with respect to age, functional status, American Society of Anesthesiologists class, steroid use, wound class, COPD, and chronic renal insufficiency. The RC accurately predicted outcomes in elective patients. Outcomes were significantly worse (p < 0.05) after the emergent operations. In emergent cases, the RC underestimated serious complications and length of stay and overestimated discharge to a skilled nursing facility (all p < 0.05). Conclusions The American College of Surgeons NSQIP RC accurately predicts outcomes for elective colorectal operations. Predicted and actual outcomes are significantly better in patients undergoing elective colon operations compared with those undergoing emergent procedures. The RC should be used with caution in emergent cases, as it has the potential to underestimate serious complications and length of stay, and overestimate discharge to skilled nursing facility. Refinement of the tool to include procedure complexity and diagnosis terms might improve its accuracy in emergent cases.