Validation of a risk prediction calculator in Australian patients undergoing head and neck microsurgery reconstruction

Amanda E Yung; Gerald Wong; Neil Pillinger; James Wykes; Roger Haddad; Stephanie McInnes; Carsten E Palme; Tsu-Hui Hubert Low; Jonathan R Clark; Robert Sanders; Sydney Ch'ng

doi:10.1016/j.bjps.2022.04.073

Validation of a risk prediction calculator in Australian patients undergoing head and neck microsurgery reconstruction

J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3323-3329. doi: 10.1016/j.bjps.2022.04.073. Epub 2022 May 1.

Authors

Affiliations

¹ The University of Sydney Sydney Medical School, Sydney, Australia; The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia.
² Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia.
³ Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia.
⁴ Department of Plastics and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia.
⁵ Department of Anaesthetics, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia.
⁶ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia.
⁷ The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia.
⁸ The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia.
⁹ The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Plastics and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Melanoma Institute of Australia, Sydney, Australia. Electronic address: sydney.chng@sydney.edu.au.

PMID: 35768291
DOI: 10.1016/j.bjps.2022.04.073

Abstract

Background: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator (SRC) is an open access calculator predicting patients' risk of postoperative complications. This study aims to assess the validity of the SRC in patients undergoing microsurgical free flap reconstruction at an Australian tertiary referral centre.

Methods: This is a retrospective cohort study of 200 consecutive patients treated up to November 2020. SRC-predicted rates of postoperative complications and hospital length of stay (LOS) were compared to those observed for the ablative and reconstructive components of the procedure. The performance of the SRC was assessed using Brier scores, area under the receiver operating characteristic (ROC) curve (AUC), and the Hosmer-Lemeshow test.

Results: For both ablative and reconstructive components, the SRC discriminates well for pneumonia and urinary tract infection, and it is calibrated well for readmission and sepsis, but it does not discriminate and calibrate well for any single outcome. SRC-predicted hospital LOS and actual LOS did not correlate well for the reconstructive component, but they correlated strongly for the ablative component.

Conclusions: The SRC is a poor predictor of postoperative complication rates and hospital LOS in patients undergoing head and neck microsurgical reconstruction.

Keywords: Free tissue flaps; Head; Neck; Postoperative outcomes; Risk.

MeSH terms

Australia / epidemiology
Humans
Microsurgery* / adverse effects
Microsurgery* / methods
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology
Quality Improvement
Retrospective Studies
Risk Assessment / methods
Risk Factors