Accuracy of the NSQIP risk calculator for predicting complications following adrenalectomy.

Autor: Walker JB; Division of Urology, Department of Surgery, College of Medicine, Penn State Health Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, BMR Building c4830B, Hershey, PA, 17033-0850, USA., Gogoj A; College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Saunders BD; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Canter DJ; Department of Urology, Ochsner Clinic, New Orleans, LA, USA., Lehman K; Division of Urology, Department of Surgery, College of Medicine, Penn State Health Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, BMR Building c4830B, Hershey, PA, 17033-0850, USA., Raman JD; Division of Urology, Department of Surgery, College of Medicine, Penn State Health Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, BMR Building c4830B, Hershey, PA, 17033-0850, USA. jraman@pennstatehealth.psu.edu.
Jazyk: angličtina
Zdroj: International urology and nephrology [Int Urol Nephrol] 2019 Aug; Vol. 51 (8), pp. 1291-1295. Date of Electronic Publication: 2019 Jun 10.
DOI: 10.1007/s11255-019-02187-1
Abstrakt: Purpose: Adrenalectomy is performed to treat functional pathology and remove tumors of malignant concern. The National Surgical Quality Improvement Program (NSQIP) risk calculator predicts 30-day complications and length of stay following index surgical procedures. We assess whether this tool accurately predicts complications following adrenalectomy procedures at a tertiary care academic medical center.
Methods: A retrospective review was performed for all adrenalectomies at a single institution from 2004 to 2016. 197 patients underwent adrenalectomy without concurrent resections. Predicted risk for NSQIP complications was calculated for each patient. The mean predicted and observed risks (%) at 30 days across all patients within each category were determined, and these were compared with two-sided one-sample t tests.
Results: Of 197 adrenalectomies, 180 were laparoscopic and 17 were open. For laparoscopic adrenalectomy, ten (5.5%) complications were observed including nine (5%) graded Clavien III or greater. All observed complication rates were significantly different than predicted (p values for all < 0.005). Mean observed length of stay was also significantly less than predicted (1.6 versus 2.1 days, p < 0.001). In the open adrenalectomy subgroup, there were no observed complications with observed mean length of stay equivalent to predicted (5.8 versus 5.3, p = 0.08) without a higher readmission rate (5.9 versus 6.0%).
Conclusions: Statistical differences were noted between the actual complication rates of adrenalectomy versus those predicted by the NSQIP calculator. Certain observed differences may not necessarily have clinical significance. Urology procedure-specific calculators may better refine predictions for sub-specialty procedures with future work requisite to determine performance across all practice settings.
Databáze: MEDLINE
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