Ability of the national surgical quality improvement program risk calculator to predict complications following total laryngectomy

Alexander L. Schneider, Christopher R. Deig, Kumar G. Prasad, Benton G. Nelson, Avinash V. Mantravadi, Joseph S. Brigance, Mark P. Langer, Mark W. McDonald, Peter A. Johnstone, Michael Moore

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

IMPORTANCE The accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature. OBJECTIVE To evaluate the accuracy of the calculator's predictions in a single institution's total laryngectomy (TL) population. DESIGN, SETTING, AND PARTICIPANTS Total laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism. MAIN OUTCOMES AND MEASURES Comparison of the NSQIP risk calculator's predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis. RESULTS Of 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67%male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165%, but underestimated surgical site infection by 7%, return to operating room by 24%, and length of stay by 13%. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications. CONCLUSIONS AND RELEVANCE The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient's risk.

Original languageEnglish (US)
Pages (from-to)972-979
Number of pages8
JournalJAMA Otolaryngology - Head and Neck Surgery
Volume142
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Fingerprint

Laryngectomy
Quality Improvement
Surgical Wound Infection
Length of Stay
Operating Rooms
Pneumonia
Sensitivity and Specificity
Free Tissue Flaps
Venous Thromboembolism
Head and Neck Neoplasms
Tertiary Care Centers
ROC Curve
Area Under Curve
Publications
Neck
Radiotherapy
Head
Population

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

Cite this

Ability of the national surgical quality improvement program risk calculator to predict complications following total laryngectomy. / Schneider, Alexander L.; Deig, Christopher R.; Prasad, Kumar G.; Nelson, Benton G.; Mantravadi, Avinash V.; Brigance, Joseph S.; Langer, Mark P.; McDonald, Mark W.; Johnstone, Peter A.; Moore, Michael.

In: JAMA Otolaryngology - Head and Neck Surgery, Vol. 142, No. 10, 01.10.2016, p. 972-979.

Research output: Contribution to journalArticle

Schneider, AL, Deig, CR, Prasad, KG, Nelson, BG, Mantravadi, AV, Brigance, JS, Langer, MP, McDonald, MW, Johnstone, PA & Moore, M 2016, 'Ability of the national surgical quality improvement program risk calculator to predict complications following total laryngectomy', JAMA Otolaryngology - Head and Neck Surgery, vol. 142, no. 10, pp. 972-979. https://doi.org/10.1001/jamaoto.2016.1809
Schneider, Alexander L. ; Deig, Christopher R. ; Prasad, Kumar G. ; Nelson, Benton G. ; Mantravadi, Avinash V. ; Brigance, Joseph S. ; Langer, Mark P. ; McDonald, Mark W. ; Johnstone, Peter A. ; Moore, Michael. / Ability of the national surgical quality improvement program risk calculator to predict complications following total laryngectomy. In: JAMA Otolaryngology - Head and Neck Surgery. 2016 ; Vol. 142, No. 10. pp. 972-979.
@article{822aeede3a0740c0bd1c0aec3ded493a,
title = "Ability of the national surgical quality improvement program risk calculator to predict complications following total laryngectomy",
abstract = "IMPORTANCE The accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature. OBJECTIVE To evaluate the accuracy of the calculator's predictions in a single institution's total laryngectomy (TL) population. DESIGN, SETTING, AND PARTICIPANTS Total laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism. MAIN OUTCOMES AND MEASURES Comparison of the NSQIP risk calculator's predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis. RESULTS Of 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67{\%}male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165{\%}, but underestimated surgical site infection by 7{\%}, return to operating room by 24{\%}, and length of stay by 13{\%}. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications. CONCLUSIONS AND RELEVANCE The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient's risk.",
author = "Schneider, {Alexander L.} and Deig, {Christopher R.} and Prasad, {Kumar G.} and Nelson, {Benton G.} and Mantravadi, {Avinash V.} and Brigance, {Joseph S.} and Langer, {Mark P.} and McDonald, {Mark W.} and Johnstone, {Peter A.} and Michael Moore",
year = "2016",
month = "10",
day = "1",
doi = "10.1001/jamaoto.2016.1809",
language = "English (US)",
volume = "142",
pages = "972--979",
journal = "JAMA Otolaryngology - Head and Neck Surgery",
issn = "2168-6181",
publisher = "American Medical Association",
number = "10",

}

TY - JOUR

T1 - Ability of the national surgical quality improvement program risk calculator to predict complications following total laryngectomy

AU - Schneider, Alexander L.

AU - Deig, Christopher R.

AU - Prasad, Kumar G.

AU - Nelson, Benton G.

AU - Mantravadi, Avinash V.

AU - Brigance, Joseph S.

AU - Langer, Mark P.

AU - McDonald, Mark W.

AU - Johnstone, Peter A.

AU - Moore, Michael

PY - 2016/10/1

Y1 - 2016/10/1

N2 - IMPORTANCE The accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature. OBJECTIVE To evaluate the accuracy of the calculator's predictions in a single institution's total laryngectomy (TL) population. DESIGN, SETTING, AND PARTICIPANTS Total laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism. MAIN OUTCOMES AND MEASURES Comparison of the NSQIP risk calculator's predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis. RESULTS Of 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67%male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165%, but underestimated surgical site infection by 7%, return to operating room by 24%, and length of stay by 13%. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications. CONCLUSIONS AND RELEVANCE The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient's risk.

AB - IMPORTANCE The accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature. OBJECTIVE To evaluate the accuracy of the calculator's predictions in a single institution's total laryngectomy (TL) population. DESIGN, SETTING, AND PARTICIPANTS Total laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism. MAIN OUTCOMES AND MEASURES Comparison of the NSQIP risk calculator's predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis. RESULTS Of 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67%male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165%, but underestimated surgical site infection by 7%, return to operating room by 24%, and length of stay by 13%. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications. CONCLUSIONS AND RELEVANCE The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient's risk.

UR - http://www.scopus.com/inward/record.url?scp=84997782967&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84997782967&partnerID=8YFLogxK

U2 - 10.1001/jamaoto.2016.1809

DO - 10.1001/jamaoto.2016.1809

M3 - Article

VL - 142

SP - 972

EP - 979

JO - JAMA Otolaryngology - Head and Neck Surgery

JF - JAMA Otolaryngology - Head and Neck Surgery

SN - 2168-6181

IS - 10

ER -