Performance of the American College of Surgeons NSQIP Surgical Risk Calculator for Total Gastrectomy.

Abstract Background To encourage implementation of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Risk Calculator for total gastrectomy for gastric cancer, its predictive performance for this specific procedure should be validated. We assessed its discriminatory accuracy and goodness of fit for predicting 12 adverse outcomes. Study Design Data on all patients with gastric cancer that underwent total gastrectomy with curative intent at Memorial Sloan Kettering Cancer Center between 2002-2017 were collected. Preoperative risk factors from the electronic medical record were manually inserted into the ACS-NSQIP Risk Calculator. Predictions for adverse outcomes were compared with observed outcomes by Brier scores, c-statistics, and Hosmer-Lemeshow p value. Results In a total of 452 patients, the predicted rate of all complications (29%) was lower than the observed rate (45%). Brier scores varied between 0.017 for death and 0.272 for any complication. C-statistics were moderate (0.7–0.8) for death and renal failure, good (0.8–0.9) for cardiac complication, and excellent (≥ 0.9) for discharge to nursing or rehabilitation facility. Hosmer-Lemeshow p value found poor goodness of fit for pneumonia only. Conclusions For adverse outcomes after total gastrectomy with curative intent in gastric cancer patients, performance of the ACS-NSQIP Risk Calculator is variable. Its predictive performance was best for cardiac complications, renal failure, death, and discharge to nursing or rehabilitation facility.