Prediction model for the need of postoperative organ support in an adult population undergoing elective major general surgery - Utilizing the American College of Surgeons - National quality improvement project (ACS-NSQIP) surgical risk calculator

Abstract

An accepted model for predicting the need for postoperative organ support and intensive care, in patients undergoing elective surgery, is lacking worldwide. A reliable tool that could predict the need for postoperative organ support would facilitate the efficient utilisation of ICU beds while ensuring patient safety. The American College of Surgeons - National Quality Improvement Project (ACS-NSQIP) surgical risk calculator is validated for the prediction of the risk of serious complications in the postoperative period. We aimed to validate this calculator to predict the need for post-operative organ support. We obtained perioperative data from 126 patients who underwent elective major general surgery. We calculated the percentage risk of serious complications for each patient using the ACS-NSQIP calculator and correlated it with the level of postoperative organ support needed. The mean predicted percentage risk of serious complications, for the group that did not require any organ support was 10.5% and the group requiring 1 or more organ support was 18.1%. The standard error was 0.49 (p= 0.001). A receiver-operating characteristic (ROC) curve gave an area under the curve of 0.71. We chose a cutoff for the percentage risk of serious complications for needing postoperative organ support and 10.8% was chosen as a fair value as it had a sensitivity of 71.4% and a specificity of 66%. The percentage risk of serious complications calculated by the ACS-NSQIP surgical risk calculator has a strong positive correlation with the need for postoperative organ support. Multi-center data is needed to determine definite cut-offs.