University of Massachusetts Medical School Faculty Publications

Title

Does the ACS NSQIP Surgical Risk Calculator Accurately Predict Complications Rates After Anterior Lumbar Interbody Fusion Procedures

UMMS Affiliation

Department of Surgery; Department of Neurological Surgery; Department of Orthopedics and Physical Rehabilitation

Publication Date

2020-12-17

Document Type

Article

Disciplines

Neurosurgery | Orthopedics | Surgery | Surgical Procedures, Operative

Abstract

STUDY DESIGN: Clinical case series.

OBJECTIVE: To determine the effectiveness of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator in the prediction of complications after anterior lumbar interbody fusion (ALIF).

SUMMARY OF BACKGROUND DATA: Identifying at-risk patients may aid in the prevention of complications after spine procedures. The ACS NSQIP surgical risk calculator was developed to predict 30-day postoperative complications for a variety of operative procedures.

METHODS: Medical records of patients undergoing ALIF at our institution from 2009-2019 were retrospectively reviewed. Demographic and comorbidity variables were entered into the ACS NSQIP surgical risk calculator to generate percentage predictions for complication incidence within 30 days postoperatively. The observed incidences of these complications were also abstracted from the medical record. The predictive ability of the ACS NSQIP surgical risk calculator was assessed in comparison to the observed incidence of complications using area under the curve (AUC) analyses.

RESULTS: Two hundred fifty-three (253) patients were analyzed. The ACS NSQIP surgical risk calculator was a fair predictor of discharge to non-home facility (AUC 0.71) and surgical site infection (AUC 0.70). The ACS NSQIP surgical risk calculator was a good predictor of acute kidney injury/progressive renal insufficiency (AUC 0.81). The ACS NSQIP surgical risk calculator was not an adequate predictive tool for any other category, including: pneumonia, urinary tract infections, venous thromboembolism, readmission, reoperations, and aggregate complications (AUC < 0.70).

CONCLUSIONS: The ACS NSQIP surgical risk calculator is an adequate predictive tool for a subset of complications after ALIF including acute kidney injury/progressive renal insufficiency, surgical site infections, and discharge to non-home facilities. However, it is a poor predictor for all other complication groups. The reliability of the ACS NSQIP surgical risk calculator is limited, and further identification of models for risk stratification are necessary for patients undergoing ALIF.Level of Evidence: 3.

Keywords

ALIF, ACS NSQIP Surgical Risk Calculator, Complications, Risk Stratification, Predictive Tools

DOI of Published Version

10.1097/BRS.0000000000003893

Source

Narain AS, Kitto AZ, Braun B, Poorman MJ, Curtin P, Slavin J, Whalen G, DiPaola CP, Connolly PJ, Stauff MP. Does the ACS NSQIP Surgical Risk Calculator Accurately Predict Complications Rates After Anterior Lumbar Interbody Fusion Procedures? Spine (Phila Pa 1976). 2020 Dec 17;Publish Ahead of Print. doi: 10.1097/BRS.0000000000003893. Epub ahead of print. PMID: 33337678. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Spine

PubMed ID

33337678

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