What question did this study set out to answer?

To assess the effectiveness of ACS-NSQIP risk estimates in guiding multidisciplinary operability decisions for complex surgical patients.

February 21, 2026

Prospective Evaluation of the Association Between American College of Surgeons-NSQIP Risk Estimates and Multidisciplinary Operability Decisions in Complex Surgical Patients

Key Result

The Non-Operability Risk Score from ACS-NSQIP outputs predicted multidisciplinary non-operability decisions with strong accuracy (AUC = 0.805, p < 0.001).

Key Points

To assess the effectiveness of ACS-NSQIP risk estimates in guiding multidisciplinary operability decisions for complex surgical patients.
Conducted a single-center prospective observational cohort study.
Included 134 complex surgical patients evaluated by a multidisciplinary committee.
Utilized standardized preoperative assessments and ACS-NSQIP estimation.
Operability decisions were made independently from ACS-NSQIP results.
Analyzed the risk deviation variable using ROC curves.
73.1% of patients were deemed operable, while 26.1% were non-operable.
The Risk Deviation variable demonstrated moderate to good discriminatory power (AUC range: 0.678–0.740).
The derived Non-Operability Risk Score had a strong correlation with committee decisions (AUC = 0.805).
Higher Non-Operability Risk Scores indicated an increased likelihood of being non-operable.
Complication rates among patients who underwent surgery did not correlate with the Non-Operability Risk Score.

Structured PICO

Does the ACS-NSQIP Surgical Risk Calculator and derived Non-Operability Risk Score accurately reflect multidisciplinary operability decisions in complex surgical patients?

Population

134 consecutive complex surgical patients evaluated by a multidisciplinary committee between November 2022 and April 2025

Intervention

ACS-NSQIP Surgical Risk Calculator estimation and derived Non-Operability Risk Score

Outcome

Ability of the NSQIP-derived Risk Deviation to discriminate between operable and non-operable patients

The ACS-NSQIP derived Non-Operability Risk Score strongly correlates with multidisciplinary operability decisions, providing a standardized tool for preoperative assessment in complex surgical patients.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

BACKGROUND: Complex surgical patients (CSP) often present with frailty, comorbidities, and limited physiological reserve, making operability decisions highly challenging. We hypothesized that parameters derived from the ACS National Surgical Quality Improvement Program (ACS-NSQIP) Surgical Risk Calculator could reflect multidisciplinary assessments of operability and support preoperative decision-making in this population. STUDY DESIGN: A single-center prospective observational cohort study included 134 consecutive complex surgical patients evaluated by a multidisciplinary committee between November 2022 and April 2025. All patients underwent standardized preoperative assessment, including ACS-NSQIP estimation, but operability decisions were made independently of the ACS-NSQIP results. The primary endpoint was the ability of the NSQIP-derived Risk Deviation to discriminate between operable and non-operable patients. This variable was analyzed using ROC curves, and findings were used to develop a Non-Operability Risk Score. RESULTS: Of the 134 patients, 98 (73.1%) were evaluated as operable and 35 (26.1%) as non-operable. The “Risk Deviation” variable showed moderate to good discriminatory power (AUC range: 0.678–0.740, all p<0.01) for outcomes such as serious complications, readmission, or death. The Non-Operability Risk Score, derived from six ACS-NSQIP outputs, correlated strongly with the committee’s operability decisions (AUC = 0.805, p<0.001) and demonstrated a significant trend: higher scores were associated with increased likelihood of non-operability. Among the 80 patients who underwent surgery, complication rates did not correlate with the Non-Operability Risk Score. CONCLUSIONS: ACS-NSQIP and particularly the derived Non-Operability Risk Score are useful tools to support multidisciplinary operability decisions in complex surgical patients. Their use may help standardize preoperative discussions, though further multicenter validation is needed to confirm generalizability.

Bookmark