Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy

Matthew T. McMillan, Valentina Allegrini, Horacio J. Asbun, Chad G. Ball, Claudio Bassi, Joal D. Beane, Stephen W. Behrman, Adam C. Berger, Mark Bloomston, Mark P. Callery, John D. Christein, Euan Dickson, Elijah Dixon, Jeffrey A. Drebin, Carlos Fernandez-Del Castillo, William E. Fisher, Zhi Ven Fong, Ericka Haverick, Robert H. Hollis, Michael G. HouseSteven J. Hughes, Nigel B. Jamieson, Tara S. Kent, Stacy J. Kowalsky, John W. Kunstman, Giuseppe Malleo, Amy L. McElhany, Ronald R. Salem, Kevin C. Soares, Michael H. Sprys, Vicente Valero, Ammara A. Watkins, Christopher Wolfgang, Amer H. Zureikat, Charles M. Vollmer

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: This multicenter study sought to evaluate the accuracy of the American College of Surgeons National Surgical Quality Improvement Programʼs (ACS-NSQIP) surgical risk calculator for predicting outcomes after pancreatoduodenectomy (PD) and to determine whether incorporating other factors improves its predictive capacity. BACKGROUND:: The ACS-NSQIP surgical risk calculator has been proposed as a decision-support tool to predict complication risk after various operations. Although it considers 21 preoperative factors, it does not include procedure-specific variables, which have demonstrated a strong predictive capacity for the most common and morbid complication after PD – clinically relevant pancreatic fistula (CR-POPF). The validated Fistula Risk Score (FRS) intraoperatively predicts the occurrence of CR-POPF and serious complications after PD. METHODS:: This study of 1480 PDs involved 47 surgeons at 17 high-volume institutions. Patient complication risk was calculated using both the universal calculator and a procedure-specific model that incorporated the FRS and surgeon/institutional factors. The performance of each model was compared using the c-statistic and Brier score. RESULTS:: The FRS was significantly associated with 30-day mortality, 90-day mortality, serious complications, and reoperation (all P <0.0001). The procedure-specific model outperformed the universal calculator for 30-day mortality (c-statistic: 0.79 vs 0.68; Brier score: 0.020 vs 0.021), 90-day mortality, serious complications, and reoperation. Neither surgeon experience nor institutional volume significantly predicted mortality; however, surgeons with a career PD volume >450 were less likely to have serious complications (P <0.001) or perform reoperations (P <0.001). CONCLUSIONS:: Procedure-specific complication risk influences outcomes after pancreatoduodenectomy; therefore, risk adjustment for performance assessment and comparative research should consider these preoperative and intraoperative factors along with conventional ACS-NSQIP preoperative variables.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - May 26 2016

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Pancreaticoduodenectomy
Quality Improvement
Morbidity
Mortality
Fistula
Reoperation
Pancreatic Fistula
Risk Adjustment
Surgeons
Multicenter Studies
Research

ASJC Scopus subject areas

  • Surgery

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Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy. / McMillan, Matthew T.; Allegrini, Valentina; Asbun, Horacio J.; Ball, Chad G.; Bassi, Claudio; Beane, Joal D.; Behrman, Stephen W.; Berger, Adam C.; Bloomston, Mark; Callery, Mark P.; Christein, John D.; Dickson, Euan; Dixon, Elijah; Drebin, Jeffrey A.; Fernandez-Del Castillo, Carlos; Fisher, William E.; Fong, Zhi Ven; Haverick, Ericka; Hollis, Robert H.; House, Michael G.; Hughes, Steven J.; Jamieson, Nigel B.; Kent, Tara S.; Kowalsky, Stacy J.; Kunstman, John W.; Malleo, Giuseppe; McElhany, Amy L.; Salem, Ronald R.; Soares, Kevin C.; Sprys, Michael H.; Valero, Vicente; Watkins, Ammara A.; Wolfgang, Christopher; Zureikat, Amer H.; Vollmer, Charles M.

In: Annals of Surgery, 26.05.2016.

Research output: Contribution to journalArticle

McMillan, MT, Allegrini, V, Asbun, HJ, Ball, CG, Bassi, C, Beane, JD, Behrman, SW, Berger, AC, Bloomston, M, Callery, MP, Christein, JD, Dickson, E, Dixon, E, Drebin, JA, Fernandez-Del Castillo, C, Fisher, WE, Fong, ZV, Haverick, E, Hollis, RH, House, MG, Hughes, SJ, Jamieson, NB, Kent, TS, Kowalsky, SJ, Kunstman, JW, Malleo, G, McElhany, AL, Salem, RR, Soares, KC, Sprys, MH, Valero, V, Watkins, AA, Wolfgang, C, Zureikat, AH & Vollmer, CM 2016, 'Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000001796
McMillan, Matthew T. ; Allegrini, Valentina ; Asbun, Horacio J. ; Ball, Chad G. ; Bassi, Claudio ; Beane, Joal D. ; Behrman, Stephen W. ; Berger, Adam C. ; Bloomston, Mark ; Callery, Mark P. ; Christein, John D. ; Dickson, Euan ; Dixon, Elijah ; Drebin, Jeffrey A. ; Fernandez-Del Castillo, Carlos ; Fisher, William E. ; Fong, Zhi Ven ; Haverick, Ericka ; Hollis, Robert H. ; House, Michael G. ; Hughes, Steven J. ; Jamieson, Nigel B. ; Kent, Tara S. ; Kowalsky, Stacy J. ; Kunstman, John W. ; Malleo, Giuseppe ; McElhany, Amy L. ; Salem, Ronald R. ; Soares, Kevin C. ; Sprys, Michael H. ; Valero, Vicente ; Watkins, Ammara A. ; Wolfgang, Christopher ; Zureikat, Amer H. ; Vollmer, Charles M. / Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy. In: Annals of Surgery. 2016.
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title = "Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy",
abstract = "OBJECTIVE:: This multicenter study sought to evaluate the accuracy of the American College of Surgeons National Surgical Quality Improvement Programʼs (ACS-NSQIP) surgical risk calculator for predicting outcomes after pancreatoduodenectomy (PD) and to determine whether incorporating other factors improves its predictive capacity. BACKGROUND:: The ACS-NSQIP surgical risk calculator has been proposed as a decision-support tool to predict complication risk after various operations. Although it considers 21 preoperative factors, it does not include procedure-specific variables, which have demonstrated a strong predictive capacity for the most common and morbid complication after PD – clinically relevant pancreatic fistula (CR-POPF). The validated Fistula Risk Score (FRS) intraoperatively predicts the occurrence of CR-POPF and serious complications after PD. METHODS:: This study of 1480 PDs involved 47 surgeons at 17 high-volume institutions. Patient complication risk was calculated using both the universal calculator and a procedure-specific model that incorporated the FRS and surgeon/institutional factors. The performance of each model was compared using the c-statistic and Brier score. RESULTS:: The FRS was significantly associated with 30-day mortality, 90-day mortality, serious complications, and reoperation (all P <0.0001). The procedure-specific model outperformed the universal calculator for 30-day mortality (c-statistic: 0.79 vs 0.68; Brier score: 0.020 vs 0.021), 90-day mortality, serious complications, and reoperation. Neither surgeon experience nor institutional volume significantly predicted mortality; however, surgeons with a career PD volume >450 were less likely to have serious complications (P <0.001) or perform reoperations (P <0.001). CONCLUSIONS:: Procedure-specific complication risk influences outcomes after pancreatoduodenectomy; therefore, risk adjustment for performance assessment and comparative research should consider these preoperative and intraoperative factors along with conventional ACS-NSQIP preoperative variables.",
author = "McMillan, {Matthew T.} and Valentina Allegrini and Asbun, {Horacio J.} and Ball, {Chad G.} and Claudio Bassi and Beane, {Joal D.} and Behrman, {Stephen W.} and Berger, {Adam C.} and Mark Bloomston and Callery, {Mark P.} and Christein, {John D.} and Euan Dickson and Elijah Dixon and Drebin, {Jeffrey A.} and {Fernandez-Del Castillo}, Carlos and Fisher, {William E.} and Fong, {Zhi Ven} and Ericka Haverick and Hollis, {Robert H.} and House, {Michael G.} and Hughes, {Steven J.} and Jamieson, {Nigel B.} and Kent, {Tara S.} and Kowalsky, {Stacy J.} and Kunstman, {John W.} and Giuseppe Malleo and McElhany, {Amy L.} and Salem, {Ronald R.} and Soares, {Kevin C.} and Sprys, {Michael H.} and Vicente Valero and Watkins, {Ammara A.} and Christopher Wolfgang and Zureikat, {Amer H.} and Vollmer, {Charles M.}",
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month = "5",
day = "26",
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language = "English (US)",
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T1 - Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy

AU - McMillan, Matthew T.

AU - Allegrini, Valentina

AU - Asbun, Horacio J.

AU - Ball, Chad G.

AU - Bassi, Claudio

AU - Beane, Joal D.

AU - Behrman, Stephen W.

AU - Berger, Adam C.

AU - Bloomston, Mark

AU - Callery, Mark P.

AU - Christein, John D.

AU - Dickson, Euan

AU - Dixon, Elijah

AU - Drebin, Jeffrey A.

AU - Fernandez-Del Castillo, Carlos

AU - Fisher, William E.

AU - Fong, Zhi Ven

AU - Haverick, Ericka

AU - Hollis, Robert H.

AU - House, Michael G.

AU - Hughes, Steven J.

AU - Jamieson, Nigel B.

AU - Kent, Tara S.

AU - Kowalsky, Stacy J.

AU - Kunstman, John W.

AU - Malleo, Giuseppe

AU - McElhany, Amy L.

AU - Salem, Ronald R.

AU - Soares, Kevin C.

AU - Sprys, Michael H.

AU - Valero, Vicente

AU - Watkins, Ammara A.

AU - Wolfgang, Christopher

AU - Zureikat, Amer H.

AU - Vollmer, Charles M.

PY - 2016/5/26

Y1 - 2016/5/26

N2 - OBJECTIVE:: This multicenter study sought to evaluate the accuracy of the American College of Surgeons National Surgical Quality Improvement Programʼs (ACS-NSQIP) surgical risk calculator for predicting outcomes after pancreatoduodenectomy (PD) and to determine whether incorporating other factors improves its predictive capacity. BACKGROUND:: The ACS-NSQIP surgical risk calculator has been proposed as a decision-support tool to predict complication risk after various operations. Although it considers 21 preoperative factors, it does not include procedure-specific variables, which have demonstrated a strong predictive capacity for the most common and morbid complication after PD – clinically relevant pancreatic fistula (CR-POPF). The validated Fistula Risk Score (FRS) intraoperatively predicts the occurrence of CR-POPF and serious complications after PD. METHODS:: This study of 1480 PDs involved 47 surgeons at 17 high-volume institutions. Patient complication risk was calculated using both the universal calculator and a procedure-specific model that incorporated the FRS and surgeon/institutional factors. The performance of each model was compared using the c-statistic and Brier score. RESULTS:: The FRS was significantly associated with 30-day mortality, 90-day mortality, serious complications, and reoperation (all P <0.0001). The procedure-specific model outperformed the universal calculator for 30-day mortality (c-statistic: 0.79 vs 0.68; Brier score: 0.020 vs 0.021), 90-day mortality, serious complications, and reoperation. Neither surgeon experience nor institutional volume significantly predicted mortality; however, surgeons with a career PD volume >450 were less likely to have serious complications (P <0.001) or perform reoperations (P <0.001). CONCLUSIONS:: Procedure-specific complication risk influences outcomes after pancreatoduodenectomy; therefore, risk adjustment for performance assessment and comparative research should consider these preoperative and intraoperative factors along with conventional ACS-NSQIP preoperative variables.

AB - OBJECTIVE:: This multicenter study sought to evaluate the accuracy of the American College of Surgeons National Surgical Quality Improvement Programʼs (ACS-NSQIP) surgical risk calculator for predicting outcomes after pancreatoduodenectomy (PD) and to determine whether incorporating other factors improves its predictive capacity. BACKGROUND:: The ACS-NSQIP surgical risk calculator has been proposed as a decision-support tool to predict complication risk after various operations. Although it considers 21 preoperative factors, it does not include procedure-specific variables, which have demonstrated a strong predictive capacity for the most common and morbid complication after PD – clinically relevant pancreatic fistula (CR-POPF). The validated Fistula Risk Score (FRS) intraoperatively predicts the occurrence of CR-POPF and serious complications after PD. METHODS:: This study of 1480 PDs involved 47 surgeons at 17 high-volume institutions. Patient complication risk was calculated using both the universal calculator and a procedure-specific model that incorporated the FRS and surgeon/institutional factors. The performance of each model was compared using the c-statistic and Brier score. RESULTS:: The FRS was significantly associated with 30-day mortality, 90-day mortality, serious complications, and reoperation (all P <0.0001). The procedure-specific model outperformed the universal calculator for 30-day mortality (c-statistic: 0.79 vs 0.68; Brier score: 0.020 vs 0.021), 90-day mortality, serious complications, and reoperation. Neither surgeon experience nor institutional volume significantly predicted mortality; however, surgeons with a career PD volume >450 were less likely to have serious complications (P <0.001) or perform reoperations (P <0.001). CONCLUSIONS:: Procedure-specific complication risk influences outcomes after pancreatoduodenectomy; therefore, risk adjustment for performance assessment and comparative research should consider these preoperative and intraoperative factors along with conventional ACS-NSQIP preoperative variables.

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