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Hope for the best, but prepare for the worst - Diagnostic accuracy of the American College of Surgeons National

Torsten Schulz1, Toralf Kirsten2, Stefan Langer1

  • 1Department of Orthopaedic, Trauma and Plastic Surgery, University Hospital Leipzig, 04103 Leipzig, Germany.

JPRAS Open
|January 23, 2025
PubMed
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The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator is unreliable for predicting outcomes in abdominoplasty patients post-massive weight loss. Actual complication rates significantly exceeded predictions, indicating limited reliability for this specific patient group.

Area of Science:

  • Plastic Surgery
  • Surgical Outcomes Research
  • Health Informatics

Background:

  • Massive weight loss often necessitates abdominoplasty to address excess skin.
  • Accurate prediction of surgical outcomes is crucial for patient counseling and resource allocation.
  • The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator is a widely used tool for predicting surgical complications.

Purpose of the Study:

  • To validate the predictive accuracy of the ACS-NSQIP risk calculator for abdominoplasty outcomes in patients who have undergone massive weight loss.
  • To assess the reliability of the ACS-NSQIP risk calculator in a specific cohort of post-bariatric surgery patients.

Main Methods:

  • Retrospective collection of patient characteristics, comorbidities, and adverse outcomes from 2013-2023.
Keywords:
ACS-NSQIP risk calculatorAbdominoplastyMassive weight lossRisk stratification

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  • Definition of adverse events according to ACS-NSQIP standards.
  • Manual calculation of predicted risks using the ACS-NSQIP risk calculator.
  • Assessment of diagnostic accuracy using binary logistic regression and Brier scores.

    • Main Results:

    • Analysis included 205 patients undergoing abdominoplasty after massive weight loss.
    • Actual complication rates (0.5%-26.3%) were significantly underestimated by the calculator's predictions (0.1%-8.6%).
    • Elevated American Society of Anesthesiologists (ASA) status and Body Mass Index (BMI) were associated with increased complications and return to the operating theatre.
    • Logistic regression models showed low sensitivity and weak odds ratios, indicating limited reliability.

    Conclusions:

    • The ACS-NSQIP risk calculator demonstrates limited reliability in predicting adverse outcomes for abdominoplasty patients following massive weight loss.
    • The study highlights the need for caution when using the current ACS-NSQIP risk calculator for this specific patient population.
    • Further refinement of risk prediction models for post-bariatric surgery patients is warranted.