Evaluating the ACS NSQIP Risk Calculator in Primary Pancreatic Neuroendocrine Tumor: Results from the US Neuroendocrine Tumor Study Group

• Authors: Apeksha Dave, Ohio State University; Eliza W Beal, Ohio State University; Alexandra G Lopez-Aguiar, Emory University; George Poultsides, Stanford University; Eleftherios Makris, Stanford University; Flavio G Rocha, Virginia Mason Medical Center; Zaheer Kanji, Virginia Mason Medical Center; Sean Ronnekleiv-Kelly, University of Wisconsin School of Medicine and Public Health; Victoria R Rendell, University of Wisconsin School of Medicine and Public Health; Ryan C Fields, Washington University; Bradley A Krasnick, Washington University; Kamran Idrees, Vanderbilt University; Paula Marincola Smith, Vanderbilt University; Hari Nathan, University of Michigan; Megan Beems, University of Michigan; Shishir Maithel, Emory University; Timothy M Pawlik, Ohio State University; Carl R Schmidt, Ohio State University; Mary E Dillhoff, Ohio State University
• Journal Title: JOURNAL OF GASTROINTESTINAL SURGERY
• Volume: Volume 23, Number 11
• Publisher: SPRINGER | 2019-11-01, Pages 2225-2231
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s11605-019-04120-4
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Gastroenterology & Hepatology; Surgery; ACS NSQIP risk calculator; Pancreatic neuroendocrine tumor; PNET; Pan-NET; CARDIAC RISK; MORTALITY; FISTULA; PREDICTION; OUTCOMES; MODELS; INDEX; SCORE

Abstract

Background: In a changing health care environment where patient outcomes will be more closely scrutinized, the ability to predict surgical complications is becoming increasingly important. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) online risk calculator is a popular tool to predict surgical risk. This paper aims to assess the applicability of the ACS NSQIP calculator to patients undergoing surgery for pancreatic neuroendocrine tumors (PNETs). Methods: Using the US Neuroendocrine Tumor Study Group (USNET-SG), 890 patients who underwent pancreatic procedures between 1/1/2000–12/31/2016 were evaluated. Predicted and actual outcomes were compared using C-statistics and Brier scores. Results: The most commonly performed procedure was distal pancreatectomy, followed by standard and pylorus-preserving pancreaticoduodenectomy. For the entire group of patients studied, C-statistics were highest for discharge destination (0.79) and cardiac complications (0.71), and less than 0.7 for all other complications. The Brier scores for surgical site infection (0.1441) and discharge to nursing/rehabilitation facility (0.0279) were below the Brier score cut-off, while the rest were equal to or above and therefore not useful for interpretation. Conclusion: This work indicates that the ACS NSQIP risk calculator is a valuable tool that should be used with caution and in coordination with clinical assessment for PNET clinical decision-making.