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Validation of the American College of Surgeons National Surgical Quality Improvement Program Risk Model for Patients Undergoing Panniculectomy

Suresh, Visakha BSE*; Levites, Heather MD; Peskoe, Sarah PhD; Hein, Rachel MD; Avashia, Yash MD; Erdmann, Detlev MD, PhD, MHSc

doi: 10.1097/SAP.0000000000001759

Panniculectomy procedures have been reported to significantly improve quality of life, increase mobility, and improve hygiene in patients with a significant pannus formation. The primary aims of this study were to determine which preoperative risk factors may be used to differentiate postoperative complication rate among patient cohorts and to validate utilization of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) risk calculator in patients undergoing panniculectomies.

Methods This retrospective study included all patients who underwent a panniculectomy procedure at our institution from 2005 to 2016. Baseline characteristics, preoperative risk factors, medical comorbidities, and postoperative complications were collected via retrospective chart review.

Results Two hundred sixty-four patients who underwent a panniculectomy were identified. The odds ratios of any postoperative complication were 8.26, 7.76, and 16.6 for patients with classes 1, 2, and 3 obesity, respectively (P < 0.05). Statistical modeling was utilized to evaluate the predictive performance of the ACS-NSQIP Surgical Risk Calculator. We calculated the C-statistic for the ACS-NSQIP model to be only 0.61, indicating that although the model is associated with the risk of complication, it does not have a strong predictive value for this particular procedure.

Discussion This study is one of the first to characterize postoperative complication rate based on extremum of body mass index for panniculectomy patients. Our results show that the utilization of the ACS-NSQIP Risk Calculator in this particular patient population underestimates the complication risk as a whole, which may necessitate the future development of a separate risk assessment model for this procedure.

From the *Duke University School of Medicine;

Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, and

Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.

Received July 5, 2018, and accepted for publication, after revision October 17, 2018.

Author Contributions: V.S.: study idea and design, data collection, data analysis and interpretation, manuscript drafting and editing. H.L.: data analysis, manuscript drafting and editing. S.P.: statistical analysis. R.H.: manuscript drafting and editing. Y.A.: study design, manuscript drafting and editing. D.E.: study idea and design, manuscript drafting and editing.

Institutional review board approval was obtained for this study.

This study was presented at the 63rd Annual Meeting of the Plastic Surgery Research Council in Birmingham, AL, in May 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Detlev Erdmann, MD, PhD, MHSc, Division of Plastic, Reconstructive, Maxillofacial and Oral Surgery, Department of Surgery, Duke University Medical Center, Box 3181, Durham, NC 27710. E-mail:

Online date: January 10, 2019

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