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Predicting Postoperative Complications in Older Patients Undergoing Head and Neck Microvascular Reconstruction Using

Sebastian Holm^1,2, Jenny Löfgren^3,4, Johann Zdolsek^1,2

¹From the Department of Plastic and Reconstructive Surgery, Örebro University Hospital, Örebro, Sweden.

Plastic and Reconstructive Surgery. Global Open

|June 27, 2025

Summary

The National Surgical Quality Improvement Program (NSQIP) risk calculator underestimates complications for head and neck cancer (HNC) patients undergoing microvascular reconstruction. This tool needs improvement for accurate prediction in HNC surgical cases.

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Area of Science:

Oncology
Surgical Outcomes
Medical Informatics

Background:

Head and neck cancer (HNC) is a prevalent global malignancy requiring multidisciplinary care.
The National Surgical Quality Improvement Program (NSQIP) risk calculator aids in predicting postoperative complications.
Its utility in HNC surgery with microvascular reconstruction requires validation.

Purpose of the Study:

To evaluate the accuracy of the NSQIP risk calculator in predicting postoperative complications.
To assess the calculator's reliability for patients undergoing head and neck cancer resection with microvascular reconstruction.

Main Methods:

Retrospective analysis of 99 HNC patients undergoing microvascular reconstruction (Jan 2016-Feb 2021).
Comparison of observed postoperative complications with NSQIP calculator predictions.
Statistical analysis using receiver operating characteristic (ROC) curves and Brier score.

Main Results:

44% of patients experienced complications; 27.2% had serious complications.
ROC analysis showed Area Under the Curve (AUC) of 0.62 for any complications and 0.65 for serious complications.
Both AUC values were below the threshold for acceptable discrimination (0.7-0.8).

Conclusions:

The NSQIP risk calculator underestimates complication likelihood in HNC patients undergoing microvascular reconstruction.
The tool's predictive accuracy is limited for this specific surgical population.
Further refinement of risk prediction models is needed for HNC surgery.