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Evaluating Postoperative Morbidity in Patients Undergoing Pelvic Reconstructive Surgery Using the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator

Boyd, Sarah S., MD*; O’Sullivan, David M., PhD; Lasala, Christine, MD*

Female Pelvic Medicine & Reconstructive Surgery: March 20, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000715
Original Article: PDF Only

Objective The aim of this study was to evaluate the ability of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator to predict surgical morbidity in patients undergoing pelvic reconstructive surgery.

Methods This was a retrospective study of patients who underwent pelvic reconstructive surgery from 2014 to 2017. Preoperative risk factors were abstracted from medical records and entered into the ACS NSQIP surgical risk calculator. The Current Procedural Terminology code that produced the largest risk was used and compared with actual patient outcomes. Demographic, clinical, and surgical characteristics were analyzed descriptively. Logistic regression evaluated significant factors associated with each outcome; prediction capability of the risk calculator was assessed.

Results Seven hundred thirty-one surgical cases were reviewed. The cohort was predominantly younger than 65 years (58.7%), white (77.4%), multiparous (81.1%), and overweight (64.7%); 76.3% were American Society of Anesthesiologists class 2, and 70.2% had vaginal surgery. There was no difference in median risk scores between those with and without postoperative event. Two hundred twenty-one (30.3%) experienced “any serious complication,” with 89% of these due to urinary tract infection. Incidence of urinary tract infection was 27%; readmission was 3.2%, and 3.6% returned to the operating room. Decreasing age was predictive of return to the operating room (P < 0.001), and increasingly worse functional status predicted discharge to nursing or skilled rehabilitation facility (P < 0.001).

Conclusions The ACS NSQIP surgical risk calculator is an overall poor predictor of actual outcomes in a sample of patients who underwent pelvic reconstructive surgery, perhaps because of low prevalence of serious events. A more accurate surgical risk calculator is needed for this patient population.

From the *Department of Female Pelvic Medicine and Reconstructive Surgery, Hartford Hospital, Hartford, CT; and

Department of Research Administration, Hartford HealthCare, Hartford, CT.

Correspondence: Sarah S. Boyd, MD, Female Pelvic Medicine and Reconstructive Surgery, Hartford Hospital, 85 Seymour St, Hartford, CT 06106. E-mail:

This study was not funded.

Institutional review board approval: HHC-2017-0211.

The authors have declared they have no conflicts of interest.

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