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Does one score fit all? Measuring risk in ulcerative colitis.

Deborah S Keller1, Kyle G Cologne2, Anthony J Senagore3

  • 1Colorectal Surgical Associates, 7900 Fannin, Suite 2700, Houston, TX, 77054, USA; Division of Colon and Rectal Surgery, Houston Methodist Hospital, Houston, TX 77030, USA.

American Journal of Surgery
|February 4, 2016
PubMed
Summary

The American College of Surgeons Surgical Risk Calculator inaccurately predicts outcomes for ulcerative colitis (UC) patients undergoing colorectal resection, overestimating some risks and underestimating others. Its limitations caution against using it for surgical quality reporting in UC.

Keywords:
ACS Surgical Risk CalculatorInflammatory bowel diseaseLaparoscopic colorectal surgeryNSQIPPatient outcomesQuality measures

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Area of Science:

  • Colorectal Surgery
  • Surgical Risk Assessment
  • Inflammatory Bowel Disease

Background:

  • The American College of Surgeons Surgical Risk Calculator aids risk stratification and surgical quality assessment.
  • Its institutional-level performance for specific conditions like ulcerative colitis (UC) remains unexamined.

Purpose of the Study:

  • To evaluate the accuracy of the American College of Surgeons Surgical Risk Calculator for patients with ulcerative colitis (UC) undergoing colorectal resection.
  • To compare predicted outcomes with actual patient results at an institutional level.

Main Methods:

  • Retrospective analysis of 70 UC patients undergoing colorectal resection.
  • Comparison of predicted outcomes (length of stay, complications, reoperation, death) from the risk calculator with actual patient outcomes.
  • Analysis of discrepancies between predicted and actual outcomes, including identification of outliers and uncalculated complications.

Main Results:

  • Actual and predicted mean length of stay (LOS) were identical but masked 14.3% of patients with significantly longer LOS outliers.
  • Actual incidence of any complication (P < .001) and major complications (P < .001) was significantly higher than predicted.
  • Common actual complications (intra-abdominal abscess, postoperative ileus, anastomotic leak) were not included in the calculator's predictions.

Conclusions:

  • The Surgical Risk Calculator demonstrates poor accuracy in predicting relevant risks and complications for ulcerative colitis (UC) patients.
  • The calculator's significant impact by outliers and failure to account for common UC-specific complications limit its utility.
  • Caution is advised when using this calculator for surgical quality reporting and determining specific patient outcomes in UC.