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01-03-2020 | Hepatocellular Carcinoma | Original Article

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

Authors: Kota Sahara, Anghela Z. Paredes, Katiuscha Merath, Diamantis I. Tsilimigras, Fabio Bagante, Francesca Ratti, Hugo P. Marques, Olivier Soubrane, Eliza W. Beal, Vincent Lam, George A. Poultsides, Irinel Popescu, Sorin Alexandrescu, Guillaume Martel, Workneh Aklile, Alfredo Guglielmi, Tom Hugh, Luca Aldrighetti, Itaru Endo, Timothy M. Pawlik

Published in: Journal of Gastrointestinal Surgery | Issue 3/2020

Abstract

Background

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.

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Title: Evaluation of the ACS NSQIP Surgical Risk Calculator in Elderly Patients Undergoing Hepatectomy for Hepatocellular Carcinoma
Authors: Kota Sahara
Anghela Z. Paredes
Katiuscha Merath
Diamantis I. Tsilimigras
Fabio Bagante
Francesca Ratti
Hugo P. Marques
Olivier Soubrane
Eliza W. Beal
Vincent Lam
George A. Poultsides
Irinel Popescu
Sorin Alexandrescu
Guillaume Martel
Workneh Aklile
Alfredo Guglielmi
Tom Hugh
Luca Aldrighetti
Itaru Endo
Timothy M. Pawlik
Publication date: 01-03-2020
Publisher: Springer US
Keywords: Hepatocellular Carcinoma
Hepatocellular Carcinoma
Published in: Journal of Gastrointestinal Surgery / Issue 3/2020
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-019-04174-4

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Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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