Adding 6 geriatric risk factors to the traditional 21-variable ACS NSQIP Surgical Risk Calculator demonstrated excellent performance (C statistic >0.8) in predicting 4 postoperative geriatric outcomes.
Observational (n=38,048)
Yes
Does the inclusion of geriatric risk factors in the ACS NSQIP Surgical Risk Calculator improve the prediction of postoperative geriatric outcomes in patients 65 years or older?
Adding geriatric-specific risk factors to the ACS NSQIP Surgical Risk Calculator improves the prediction of postoperative complications such as delirium and functional decline in older adults.
Effect estimate: C statistic >0.8
BACKGROUND: The American College of Surgeons (ACS) NSQIP Surgical Risk Calculator (SRC) plays an important role in risk prediction and decision-making. We sought to enhance the existing ACS NSQIP SRC with functionality to predict geriatric-specific outcomes and assess the predictive value of geriatric-specific risk factors by comparing performance in outcomes prediction using the traditional ACS NSQIP SRC with models that also included geriatric risk factors. STUDY DESIGN: Data were collected from 21 ACS NSQIP Geriatric Surgery Pilot Project hospitals between 2014 and 2017. Hierarchical regression models predicted 4 postoperative geriatric outcomes (ie pressure ulcer, delirium, new mobility aid use, and functional decline) using the traditional 21-variable ACS NSQIP SRC models and 27-variable models that included 6 geriatric risk factors (ie living situation, fall history, mobility aid use, cognitive impairment, surrogate-signed consent, and palliative care on admission). RESULTS: Data from 38,048 patients 65 years or older undergoing 197 unique operations across 10 surgical subspecialties were used. Stable model discrimination and calibration between developmental and validation datasets confirmed predictive validity. Models with and without geriatric risk factors demonstrated excellent performance (C statistic >0.8) with inclusion of geriatric risk factors improving performance. Of the 21 ACS NSQIP variables, CPT code, COPD, age, functional dependence, sex, disseminated cancer, diabetes, and sepsis were the strongest risk predictors, and impaired cognition, fall history, and mobility aid use were the strongest geriatric predictors. CONCLUSIONS: The ACS NSQIP SRC can predict 4 unique outcomes germane to geriatric surgical patients, with improvement of predictive capability after accounting for geriatric risk factors. Augmentation of ACS NSQIP SRC can enhance shared decision-making to improve the quality of surgical care in older adults.
Hornor et al. (Mon,) conducted a observational in Geriatric surgical patients (n=38,048). 27-variable ACS NSQIP SRC models including 6 geriatric risk factors vs. Traditional 21-variable ACS NSQIP SRC models was evaluated on 4 postoperative geriatric outcomes (pressure ulcer, delirium, new mobility aid use, and functional decline) (C statistic >0.8). Adding 6 geriatric risk factors to the traditional 21-variable ACS NSQIP Surgical Risk Calculator demonstrated excellent performance (C statistic >0.8) in predicting 4 postoperative geriatric outcomes.