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Evaluation of the ACS NSQIP Surgical Risk Calculator in Elderly Patients Undergoing Hepatectomy for Hepatocellular Carcinoma

  • Kota Sahara
  • Anghela Z. Paredes
  • Katiuscha Merath
  • Diamantis I. Tsilimigras
  • Fabio Bagante
  • Francesca Ratti
  • Hugo P. Marques
  • Olivier Soubrane
  • Eliza W. Beal
  • Vincent Lam
  • George A. Poultsides
  • Irinel Popescu
  • Sorin Alexandrescu
  • Guillaume Martel
  • Workneh Aklile
  • Alfredo Guglielmi
  • Tom Hugh
  • Luca Aldrighetti
  • Itaru Endo
  • Timothy M. PawlikEmail author
Original Article
  • 29 Downloads

Abstract

Background

The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator (SRC) aims to help predict patient-specific risk for morbidity and mortality. The performance of the SRC among an elderly population undergoing curative-intent hepatectomy for hepatocellular carcinoma (HCC) remains unknown.

Methods

Patients > 70 years of age who underwent hepatectomy for HCC between 1998 and 2017 were identified using a multi-institutional international database. To estimate the performance of SRC, 12 observed postoperative outcomes were compared with median SRC-predicted risk, and C-statistics and Brier scores were calculated.

Results

Among 500 patients, median age was 75 years (IQR 72–78). Most patients (n = 324, 64.8%) underwent a minor hepatectomy, while 35.2% underwent a major hepatectomy. The observed incidence of venous thromboembolism (VTE) (3.2%) and renal failure (RF) (4.4%) exceeded the median predicted risk (VTE, 1.8%; IQR 1.5–3.1 and RF, 1.0%; IQR 0.5–2.0). In contrast, the observed incidence of 30-day readmission (7.0%) and non-home discharge (2.5%) was lower than median-predicted risk (30-day readmission, 9.4%; IQR 7.4–12.8 and non-home discharge, 5.7%; IQR 3.3–11.7). Only 57.8% and 71.2% of patients who experienced readmission (C-statistic, 0.578; 95%CI 0.468–0.688) or mortality (C-statistic, 0.712; 95%CI 0.508–0.917) were correctly identified by the model.

Conclusion

Among elderly patients undergoing hepatectomy for HCC, the SRC underestimated the risk of complications such as VTE and RF, while being no better than chance in estimating the risk of readmission. The ACS SRC has limited clinical applicability in estimating perioperative risk among elderly patients being considered for hepatic resection of HCC.

Keywords

NSQIP Risk calculator Elderly Hepatectomy 

Notes

Compliance with Ethical Standards

The study was approved by the Institutional Review Boards of all participating institutions.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Kota Sahara
    • 1
    • 2
  • Anghela Z. Paredes
    • 1
  • Katiuscha Merath
    • 1
  • Diamantis I. Tsilimigras
    • 1
  • Fabio Bagante
    • 3
  • Francesca Ratti
    • 4
  • Hugo P. Marques
    • 5
  • Olivier Soubrane
    • 6
  • Eliza W. Beal
    • 1
  • Vincent Lam
    • 7
  • George A. Poultsides
    • 8
  • Irinel Popescu
    • 9
  • Sorin Alexandrescu
    • 9
  • Guillaume Martel
    • 10
  • Workneh Aklile
    • 10
  • Alfredo Guglielmi
    • 3
  • Tom Hugh
    • 11
  • Luca Aldrighetti
    • 4
  • Itaru Endo
    • 2
  • Timothy M. Pawlik
    • 1
    Email author
  1. 1.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer ResearchThe Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of Gastroenterological SurgeryYokohama City University School of MedicineYokohamaJapan
  3. 3.Department of SurgeryUniversity of VeronaVeronaItaly
  4. 4.Department of SurgeryOspedale San RaffaeleMilanItaly
  5. 5.Department of SurgeryCurry Cabral HospitalLisbonPortugal
  6. 6.Department of Hepatobiliopancreatic SurgeryAPHP, Beaujon HospitalClichyFrance
  7. 7.Department of SurgeryWestmead HospitalSydneyAustralia
  8. 8.Department of SurgeryStanford UniversityStanfordUSA
  9. 9.Department of SurgeryFundeni Clinical InstituteBucharestRomania
  10. 10.Department of SurgeryUniversity of OttawaOttawaCanada
  11. 11.Department of SurgeryThe University of Sydney, School of MedicineSydneyAustralia

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