The American College of Surgeons cites "design limitations" of 21 studies questioning the value of its National Surgical Quality Improvement Program Surgical Risk Calculator.
Researchers from the American College of Surgeons are questioning the validity of more than 20 papers that have found flaws in a tool designed by ACS to measure the risks of surgery.
The tool in question is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Surgical Risk Calculator (SRC).
Researchers from the ACS and the surgical departments of the University of California Los Angeles and Washington University, St. Louis, published their findings online at the Journal of the American College of Surgeons website ahead of print publication later this year.
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According to the ACS, the tool, which was released in 2013, allows surgeons to enter 23 preoperative patient risk factors and estimate risks for mortality and complications. In a media release the group called it "an accurate, preeminent tool for estimating patients' surgical risk."
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ASC researchers have looked at 21 studies challenging the tool's validity and determined that the studies had design limitations. As a result, they "should not disqualify the SRC for its intended goal—to provide a general purpose estimate of complication risk across a wide variety of operations."
Among the findings of studies challenging the tool:
- In March, researchers questioned the value of the tool for emergency surgery. "Further studies are needed to validate this risk calculator and to determine its bedside applicability," they wrote.
- Another study found the tool is "not a valid tool for the field of plastic surgery without further research to develop accurate risk stratification tools."
- In January, a study of colorectal surgery cases found the tool "underestimated the surgical site infection and overall complication rates. "
The ACS researchers cite problems with the studies' sample sizes, case mixes, and "the scope of the data sets." For example, they say most of the studies were based on data from a single institution.
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"The calculator provides an estimate for the average NSQIP hospital, but it is unlikely that any of these institutions represents the precisely average hospital…These findings suggest that, as much as possible, external validation studies of SRC prognostic models should be based on large, multi-institution, data sets."