Repository logo
 
Publication

Evaluation of the ACS NSQIP Surgical Risk Calculator in Elderly Patients Undergoing Hepatectomy for Hepatocellular Carcinoma

2020Journal article Open access
Simple item page
dc.contributor.authorSahara, K
dc.contributor.authorParedes, A
dc.contributor.authorMerath, K
dc.contributor.authorTsilimigras, D
dc.contributor.authorBagante, F
dc.contributor.authorRatti, F
dc.contributor.authorPinto Marques, H
dc.contributor.authorSoubrane, O
dc.contributor.authorBeal, E
dc.contributor.authorLam, V
dc.contributor.authorPoultsides, G
dc.contributor.authorPopescu, I
dc.contributor.authorAlexandrescu, S
dc.contributor.authorMartel, G
dc.contributor.authorAklile, W
dc.contributor.authorGuglielmi, A
dc.contributor.authorHugh, T
dc.contributor.authorAldrighetti, L
dc.contributor.authorEndo, I
dc.contributor.authorPawlik, T
dc.date.accessioned2021-04-14T13:40:16Z
dc.date.available2021-04-14T13:40:16Z
dc.date.issued2020
dc.description.abstractBackground: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator (SRC) aims to help predict patient-specific risk for morbidity and mortality. The performance of the SRC among an elderly population undergoing curative-intent hepatectomy for hepatocellular carcinoma (HCC) remains unknown. Methods: Patients > 70 years of age who underwent hepatectomy for HCC between 1998 and 2017 were identified using a multi-institutional international database. To estimate the performance of SRC, 12 observed postoperative outcomes were compared with median SRC-predicted risk, and C-statistics and Brier scores were calculated. Results: Among 500 patients, median age was 75 years (IQR 72-78). Most patients (n = 324, 64.8%) underwent a minor hepatectomy, while 35.2% underwent a major hepatectomy. The observed incidence of venous thromboembolism (VTE) (3.2%) and renal failure (RF) (4.4%) exceeded the median predicted risk (VTE, 1.8%; IQR 1.5-3.1 and RF, 1.0%; IQR 0.5-2.0). In contrast, the observed incidence of 30-day readmission (7.0%) and non-home discharge (2.5%) was lower than median-predicted risk (30-day readmission, 9.4%; IQR 7.4-12.8 and non-home discharge, 5.7%; IQR 3.3-11.7). Only 57.8% and 71.2% of patients who experienced readmission (C-statistic, 0.578; 95%CI 0.468-0.688) or mortality (C-statistic, 0.712; 95%CI 0.508-0.917) were correctly identified by the model. Conclusion: Among elderly patients undergoing hepatectomy for HCC, the SRC underestimated the risk of complications such as VTE and RF, while being no better than chance in estimating the risk of readmission. The ACS SRC has limited clinical applicability in estimating perioperative risk among elderly patients being considered for hepatic resection of HCC.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Gastrointest Surg. 2020 Mar;24(3):551-559.pt_PT
dc.identifier.doi10.1007/s11605-019-04174-4pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3650
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.subjectHCC CIRpt_PT
dc.subjectAgedpt_PT
dc.subjectCarcinoma, Hepatocellular / surgerypt_PT
dc.subjectHepatectomy / adverse effectspt_PT
dc.subjectLiver Neoplasms / surgerypt_PT
dc.subjectHumans
dc.subjectPostoperative Complications / epidemiology
dc.subjectPostoperative Complications / etiology
dc.subjectQuality Improvement
dc.subjectRetrospective Studies
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.titleEvaluation of the ACS NSQIP Surgical Risk Calculator in Elderly Patients Undergoing Hepatectomy for Hepatocellular Carcinomapt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage559pt_PT
oaire.citation.issue3pt_PT
oaire.citation.startPage551pt_PT
oaire.citation.titleJournal of Gastrointestinal Surgerypt_PT
oaire.citation.volume24pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
J Gastrointest Surg 2020 551.pdf
Size:
711.12 KB
Format:
Adobe Portable Document Format
Download

Collections

CIR - Artigos