NSQIP surgical risk calculator: a useful adjunct for the urology multidisciplinary meeting

Surgical risk calculators are not often routinely used in Urology Multidisciplinary Meetings (MDM), and little is known about their impact on clinical decision-making. The aim of this study is to assess the utility of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator for decision-making in the Urology MDM setting, with particular consideration given to decisions about surgical candidacy.

We analysed all adult patients discussed in our Urology MDM with urological conditions whose management plan could potentially include major surgery. During a MDM, a consensus management decision was made prior to the NSQIP score being revealed to blinded team members. Any change in decision after revealing the score was documented, including rationale.

Sixty-three out of 64 eligible cancer cases being discussed at MDM warranted NSQIP scores being revealed to the MDM post initial consensus. 95.2% (n = 60) did not have a change in the MDM management plan after reveal of NSQIP score. The NSQIP score led to a change in the MDM management decision in three cases: two renal cancer cases where management changed to biopsy with view to microwave ablation if positive, and one prostate cancer case, where management changed to recommend against radical prostatectomy.

The NSQIP risk calculator was a useful tool and adjunct in the MDM setting. It served as a safety net where surgical risk was not initially properly estimated by team members, and reinforced decisions where there was concordance between NSQIP score and clinical judgement.