Key result
A new risk prediction model combining ACS-NSQIP and ARISCAT predicted serious postoperative complications in head and neck surgery with an area under the curve of 0.750 (95% CI 0.63-0.87).
Why the study?
Tools were needed to identify head and neck surgery patients at risk for perioperative complications to implement prehabilitation programmes.
Does a combined risk prediction model improve the prediction of postoperative complications and mortality in patients undergoing head and neck surgery?
Cohort (n=128)
No
Does a combined risk prediction model improve the prediction of postoperative complications and mortality in patients undergoing head and neck surgery?
Effect estimate: AUC 0.750 (95% CI 0.63-0.87)
Combining ACS-NSQIP and ARISCAT risk calculators provides better prediction of serious postoperative complications in head and neck surgery than individual scores.
May support combined risk stratification in head and neck surgery; hypothesis-generating and requires prospective validation before adoption.
PURPOSE: To validate tools to identify patients at risk for perioperative complications to implement prehabilitation programmes in head and neck surgery (H&N). METHODS: Retrospective cohort including 128 patients submitted to H&N, with postoperative Intermediate Care Unit admittance. The accuracy of the risk calculators ASA, P-POSSUM, ACS-NSQIP and ARISCAT to predict postoperative complications and mortality was assessed. A multivariable analysis was subsequently performed to create a new risk prediction model for serious postoperative complications in our institution. RESULTS: Our 30-day morbidity and mortality were 45.3% and 0.8%, respectively. The ACS-NSQIP failed to predict complications and had an acceptable discrimination ability for predicting death. The discrimination ability of ARISCAT for predicting respiratory complications was acceptable. ASA and P-POSSUM were poor predictors for mortality and morbidity. Our new prediction model included ACS-NSQIP and ARISCAT (area under the curve 0.750, 95% confidence intervals: 0.63-0.87). CONCLUSION: Despite the insufficient value of these risk calculators when analysed individually, we designed a risk tool combining them which better predicts the risk of serious complications.
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Menezes et al. (2020) conducted a cohort in head and neck surgery (n=128). New risk prediction model combining ACS-NSQIP and ARISCAT was evaluated on serious postoperative complications (AUC 0.750, 95% CI 0.63-0.87). A new risk prediction model combining ACS-NSQIP and ARISCAT predicted serious postoperative complications in head and neck surgery with an area under the curve of 0.750 (95% CI 0.63-0.87).
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