Key result
NSQIP surgical risk calculator underpredicts actual complication risk in head and neck surgery by ~14%.
Why the study?
The study was conducted to assess the efficacy of the National Surgical Quality Improvement Program surgical risk calculator in predicting postoperative complications in head and neck surgery.
Does the National Surgical Quality Improvement Program surgical risk calculator accurately predict postoperative complications in patients undergoing head and neck surgery?
Meta-Analysis (n=1,774)
Does the National Surgical Quality Improvement Program surgical risk calculator accurately predict postoperative complications in patients undergoing head and neck surgery?
Absolute Event Rate: 21.8% vs 35.9%
The NSQIP surgical risk calculator significantly underpredicts complications and is ineffective for predicting outcomes in head and neck surgery.
Clinicians should not rely on the NSQIP calculator for head and neck procedures; challenges its accuracy and supports specialty-specific alternatives.
BACKGROUND: The National Surgical Quality Improvement Program surgical risk calculator (SRC) estimates the risk for postoperative complications. This meta-analysis assesses the efficacy of the SRC in the field of head and neck surgery. METHODS: A systematic review identified studies comparing the SRC's predictions to observed outcomes following head and neck surgeries. Predictive accuracy was assessed using receiver operating characteristic curves (AUCs) and Brier scoring. RESULTS: Nine studies totaling 1774 patients were included. The SRC underpredicted the risk of all outcomes (including any complication [observed (ob) = 35.9%, predicted (pr) = 21.8%] and serious complication [ob = 28.7%, pr = 17.0%]) except mortality (ob = 0.37%, pr = 1.55%). The observed length of stay was more than twice the predicted length (p < 0.02). Discrimination was acceptable for postoperative pneumonia (AUC = 0.778) and urinary tract infection (AUC = 0.782) only. Predictive accuracy was low for all outcomes (Brier scores ≥0.01) and comparable for patients with and without free-flap reconstructions. CONCLUSION: The SRC is an ineffective instrument for predicting outcomes in head and neck surgery.
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Harris et al. (2024) conducted a meta-analysis in Head and neck surgery (n=1,774). National Surgical Quality Improvement Program surgical risk calculator (SRC) vs. Observed outcomes was evaluated on Any complication. The National Surgical Quality Improvement Program surgical risk calculator underpredicted the risk of any complication (21.8% predicted vs 35.9% observed) in head and neck surgery.
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