Int J Gynaecol Obstet. 2021 Dec 20. doi: 10.1002/ijgo.14075. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate the American College of Surgeons surgical risk calculator’s reliability in predicting outcomes in hysterectomies.
METHODS: This is a prospective cohort study at a large community-based hospital. 21 preoperative and postoperative criteria were abstracted from the electronic medical record and entered into the online ACS calculator to determine a risk score. Logistical regression was used to determine the association between risk score and actual outcome. The prediction capability was analyzed with c-statistic, Hosmer-Lemeshow and Brier score.
RESULTS: 634 hysterectomies were performed during the study period from January to April 2019. Patients were predominantly 55 years old, white (53%) and overweight (BMI 30). Predicted perioperative adverse events were significantly higher than actual adverse events across all domains. 54/634 (8.5%) patients experienced postoperative urinary tract infection. C-statistic for return to operating room, renal failure, and readmission were 0.607 (95% C-statistic index [CI] 0.370-0.845), 0.882 (95% CI 0.802-0.962), 0.637 (95% CI 0.524-0.750) respectively. Brier scores approached one in all categorical domains.
CONCLUSION: The ACS surgical risk calculator holds the promise of predicting postoperative complications or length of stay for patients undergoing hysterectomy. Further adjustment to this tool is required before it can be advocated for use in the clinical setting.
PMID:34929052 | DOI:10.1002/ijgo.14075
