Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May 17;10(2):e010993.
doi: 10.1136/heartasia-2017-010993. eCollection 2018.

Validation of the American College of Surgeons Risk Calculator for preoperative risk stratification

Ma Krizia Camille Yap  1   2 , Kevin Francis Ang  1 , Lea Arceli Gonzales-Porciuncula  2 , Evelyn Esposo  1   2
Affiliations

Validation of the American College of Surgeons Risk Calculator for preoperative risk stratification

Ma Krizia Camille Yap et al. Heart Asia. .

Abstract

Objective: Various risk prediction models are available to stratify patients before non-cardiac surgery and pave the way for anticipative and preventive measures. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator is an extensive tool that predicts the risk for major adverse cardiovascular events (MACE) and other perioperative outcomes. This study validated the calculator in a Filipino population and compared its predictive ability with the more widely used Revised Cardiac Risk Index (RCRI).

Methods: The study included 424 patients referred for preoperative stratification before non-cardiac surgery in St Luke's Medical Center Quezon City. The development of all-cause mortality, morbidity, pneumonia, cardiac events, venous thromboembolism, urinary tract infection, renal failure and return to operating room were observed. The discriminative ability of the ACS NSQIP to predict these outcomes was evaluated using the area under the receiver operating characteristic curve (AUC) while calibration was measured using the Brier score. The AUC of the ACS NSQIP was compared with that of the RCRI.

Results: The ACS NSQIP Surgical Risk Calculator had excellent predictive ability for MACE and was comparable with the RCRI (AUC 0.93 vs 0.93). It also had acceptable predictive ability for pneumonia (AUC 0.93), all-cause mortality (AUC 0.89) and morbidity (AUC 0.88). It had poor to fair predictive ability for renal failure, return to operating room, surgical site infection, urinary tract infection and venous thromboembolism. Calibration was excellent for all-cause mortality, morbidity, pneumonia, venous thromboembolism and renal failure.

Conclusion: The ACS NSQIP Surgical Risk Calculator is a valid tool for predicting MACE and other important perioperative outcomes among Filipinos.

Keywords: community cardiology; general practice; primary care.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Screenshot of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator interactive web-based tool. BMI, body mass index; COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Sample of perioperative risks generated using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator. HTN, hypertension; OR, operating room.
Figure 3
Figure 3
AUC of the (A) ACS NSQIP Risk Calculator and (B) RCRI for predicting MACE. ACS, American College of Surgeons; AUC, area under the receiver operating characteristic curve; MACE, major adverse cardiac events; NSQIP, National Surgical Quality Improvement Program; RCRI, Revised Cardiac Risk Index.
See this image and copyright information in PMC

References

    1. Fleisher LA, Fleischmann KE, Auerbach AD, et al. . 2014 ACC/AHA Guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;130:2215–45. doi:10.1161/CIR.0000000000000105 - DOI - PubMed
    1. Lee TH, Marcantonio ER, Mangione CM, et al. . Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999;100:1043–9. doi:10.1161/01.CIR.100.10.1043 - DOI - PubMed
    1. Ford MK, Beattie WS, Wijeysundera DN. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Intern Med 2010;152:26 doi:10.7326/0003-4819-152-1-201001050-00007 - DOI - PubMed
    1. Bilimoria KY, Liu Y, Paruch JL, et al. . Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013;217:833–42. doi:10.1016/j.jamcollsurg.2013.07.385 - DOI - PMC - PubMed
    1. Gupta PK, Gupta H, Sundaram A, et al. . Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation 2011;124:381–7. doi:10.1161/CIRCULATIONAHA.110.015701 - DOI - PubMed

LinkOut - more resources