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. 2024 Jun 22;16(13):2297.
doi: 10.3390/cancers16132297.

Head-to-Head Comparison: P-POSSUM and ACS-NSQIP® in Predicting Perioperative Risk in Robotic Surgery for Gynaecological Cancers

Lusine Sevinyan  1   2 , Hasanthi Asaalaarchchi  1 , Anil Tailor  1 , Peter Williams  3 , Matthew Evans  4 , Darragh Hodnett  4 , Darshana Arakkal  1 , Pradeep Prabhu  4 , Melanie S Flint  2 , Thumuluru Kavitha Madhuri  1   2
Affiliations

Head-to-Head Comparison: P-POSSUM and ACS-NSQIP® in Predicting Perioperative Risk in Robotic Surgery for Gynaecological Cancers

Lusine Sevinyan et al. Cancers (Basel). .

Abstract

Purpose: In this retrospective pilot study, we aim to evaluate the accuracy and reliability of the P-POSSUM and ACS-NSQIP surgical risk calculators in predicting postoperative complications in gynaecological-oncological (GO) robotic surgery (RS). Methods: Retrospective data collection undertaken through a dedicated GO database and patient notes at a tertiary referral cancer centre. Following data lock with the actual post-op event/complication, the risk calculators were used to measure predictive scores for each patient. Baseline analysis of 153 patients, based on statistician advice, was undertaken to evaluate P-POSSUM and ACS-NSQIP validity and relevance in GO patients undergoing RS performed. Results: P-POSSUM reports on mortality and morbidity only; ACS-NSQIP reports some individual complications as well. ACS-NSQIP risk prediction was most accurate for venous thromboembolism (VTE) (area under the curve (AUC)-0.793) and pneumonia (AUC-0.657) and it showed 90% accuracy in prediction of five major complications (Brier score 0.01). Morbidity was much better predicted by ACS-NSQIP than by P-POSSUM (AUC-0.608 vs. AUC-0.551) with the same result in mortality prediction (Brier score 0.0000). Moreover, a statistically significant overestimation of morbidity has been shown by the P-POSSUM calculator (p = 0.018). Conclusions: Despite the limitations of this pilot study, the ACS-NSQIP risk calculator appears to be a better predictor of major complications and mortality, making it suitable for use by GO surgeons as an informed consent tool. Larger data collection and analyses are ongoing to validate this further.

Keywords: ACS-NSQIP; P-POSSUM; gynaecological oncology; morbidity; mortality; preoperative; risk prediction.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
The ROC area under the curve (AUC), which ranges from 0.0 to 1.0, is a diagnostic measure for evaluating the accuracy of a predictor. The diagonal green reference line has an AUC of 0.5 and means random guessing. This ROC curve represents the comparative analysis of ACS-NSQIP and P-POSSUM general morbidity prediction.
Figure 2
Figure 2
Logistic regression charts for postoperative prediction value of the ACS-NSQIP surgical risk calculator. (a) VTE (AUC = 0.793), (b) pneumonia (AUC = 0.657), (c) readmission (AUC = 0.587), (d) UTI (AUC = 0.515). The diagonal green reference line has an AUC of 0.5 and means random guessing. This ROC curves represent the analysis of specific complications ACS-NSQIP predictions.
Figure 3
Figure 3
Brier score measures the accuracy of probabilistic predictions: the lower the Brier score is for a set of predictions, the better the predictions are calibrated. (a) Mortality prediction: ACS (Brier Score 0.000), P-POSSUM (Brier score 0.0014). (b) Morbidity prediction: ACS (Brier score 0.1827), P-POSSUM (Brier score 0.1359).
Figure 4
Figure 4
ACS-NSQIP predictive ability of postoperative complications.
See this image and copyright information in PMC

References

    1. Kinnersley P., Phillips K., Savage K., Kelly M.J., Farrell E., Morgan B., Whistance R., Lewis V., Mann M.K., Stephens B.L., et al. Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures. Cochrane Database Syst. Rev. 2013;2013:1–247. doi: 10.1002/14651858.CD009445.PUB2. - DOI - PMC - PubMed
    1. Perrenoud B., Velonaki V.S., Bodenmann P., Ramelet A.S. The effectiveness of health literacy interventions on the informed consent process of health care users: A systematic review protocol. JBI Database Syst. Rev. Implement. Rep. 2015;13:82–94. doi: 10.11124/JBISRIR-2015-2304. - DOI - PubMed
    1. Bowling A., Rowe G., Lambert N., Waddington M., Mahtani K., Kenten C., Howe A., Francis S. The measurement of patients’ expectations for health care: A review and psychometric testing of a measure of patients’ expectations. Health Technol. Assess. 2012;16:1–515. doi: 10.3310/HTA16300. - DOI - PubMed
    1. Stacey D., Légaré F., Col N.F., Bennett C.L., Barry M.J., Eden K.B., Holmes-Rovner M., Llewellyn-Thomas H., Lyddiatt A., Thomson R., et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst. Rev. 2014;2014:CD001431. doi: 10.1002/14651858.CD001431.PUB4. - DOI - PubMed
    1. Sung H., Ferlay J., Siegel R.L., Laversanne M., Soerjomataram I., Jemal A., Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021;71:209–249. doi: 10.3322/CAAC.21660. - DOI - PubMed

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