ACS-NSQIP risk calculator predicts cohort but not individual risk of complication following colorectal resection

Objective: Compare the ACS-NSQIP risk calculator with institutional risk for colorectal surgery. Methods: Actual and predicted outcomes were compared for both cohort and individuals. Results: For the cohort, the risk calculator was accurate for 7/8 outcomes; there were more serious complications than predicted (19.4 vs 14.7%, p < 0.05). Risk calculator Brier scores and null Brier scores were comparable. Patients: with better outcomes than predicted were current smokers (OR 4.3 95% CI 1.2-15.4), ASA >= 3 (OR 10.4, 95% CI 2.8-39.2), underwent total/subtotal colectomy (OR 3.5, 95% CI 1.1-12.2) or operated by Surgeon 2 (OR 2.9, 95% CI 1.4-11.6). Patients with serious complications who had low predicted risk had low ASA (OR 10.5, 95% CI 1.3-82.6), and underwent operation by Surgeon 2 (OR 11.8, 95% CI 2.5, 55.2). Limitations: Single center study, sample size may bias subgroup analyses. Conclusions: The ACS NSQIP calculator did not predict outcome better than sample risk. (C) 2018 Elsevier Inc. All rights reserved.