0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Ability of the National Surgical Quality Improvement Program Risk Calculator to Predict Complications Following Total Laryngectomy ONLINE FIRST

Alexander L. Schneider, MD1; Christopher R. Deig, BA2; Kumar G. Prasad, MD2; Benton G. Nelson, MD2; Avinash V. Mantravadi, MD2; Joseph S. Brigance, MD, MS2; Mark P. Langer, MD3; Mark W. McDonald, MD4; Peter A. Johnstone, MD5; Michael G. Moore, MD2
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
2Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
3Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
4Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
5Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
JAMA Otolaryngol Head Neck Surg. Published online July 28, 2016. doi:10.1001/jamaoto.2016.1809
Text Size: A A A
Published online

Importance  The accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature.

Objective  To evaluate the accuracy of the calculator’s predictions in a single institution’s total laryngectomy (TL) population.

Design, Setting, and Participants  Total laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism.

Main Outcomes and Measures  Comparison of the NSQIP risk calculator’s predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis.

Results  Of 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67% male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165%, but underestimated surgical site infection by 7%, return to operating room by 24%, and length of stay by 13%. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications.

Conclusions and Relevance  The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient’s risk.

Figures in this Article

Figures

Place holder to copy figure label and caption
Figure 1.
Predicted vs Observed Number of Complications

The predicted number of complications was derived from the National Surgical Quality Improvement Program estimation of risk. This graph provides a general comparison of total predicted vs observed complications without directly analyzing the predictive accuracy of the calculator; N = 49.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Brier Scores of All Perioperative Complications Investigated in Patients Undergoing Total Laryngectomy

A value of less than 0.01 indicates approximately a 90% forecast accuracy. The solid horizontal line illustrates this theoretical threshold for an acceptable predictive model. There were no observed venous thromboembolisms during this study; therefore, interpretation of predicted venous thromboembolisms is limited. CRT indicates chemoradiation therapy, and RT, radiation therapy.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Receiver Operating Characteristic Curve for Surgical Site Infection (SSI) in Patients Undergoing Total Laryngectomy With Free Flap Reconstruction

This graph helps to represent the sensitivity and specificity of the National Surgical Quality Improvement Program calculator for this subgroup. There is a significant difference between the receiver operating characteristic curve for predicted SSI and the null hypothesis (diagonal line), indicating that the NSQIP calculator is better than chance alone at predicting SSI in this subgroup; area under the curve = 0.83.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Pearson r Values Comparing Predicted to Observed Length of Stay in All Total Laryngectomy Subgroups

There are no correlations in any subgroup between predicted and observed length of stay. CRT indicates chemoradiation therapy, and RT, radiation therapy.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

143 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();