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Head and Neck Surgery

(488) The Efficacy of the NSQIP-SRC in Head and Neck Surgery

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • JH

    Jacob C. Harris, BA

    Medical Student
    Perelman School of Medicine
    Philadelphia, PA, United States

    • Co-Author(s)

  • Vinayak S. Ahluwalia, BS

    Medical Student
    Perelman School of Medicine, University of Pennsylvania
    Philadelphia, PA, USA

  • Katherine E. Xu, BS

    Medical Student
    Perelman School of Medicine At the University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • DR

    Dominic Romeo, MS

    Student
    Perelman School of Medicine, University of Pennsylvania
    Philadelphia, PA, United States

    • Senior Author(s)

  • Karthik Rajasekaran, MD

    Assistant Professor, Head and Neck Oncologic & Reconstructive Surgeon, Director of QI
    Department of Otorhinolaryngology – Head & Neck Surgery, University of Pennsylvania
    Philadelphia, Pennsylvania, United States

Disclosure(s):
Jacob C. Harris, BA: No relevant relationships to disclose.
Katherine E. Xu, BS: No relevant relationships to disclose.
Karthik Rajasekaran, MD: No relevant relationships to disclose.


Introduction: The American College of Surgeons’ National Surgical Quality Improvement Program’s (NSQIP) Surgical Risk Calculator (SRC) estimates a patient’s risks for post-operative complications. This project is a meta-analysis assessing the efficacy of the SRC in the field of head and neck oncologic reconstruction.

Methods: A systematic review was conducted. Studies comparing the SRC’s predictions to observed outcomes following head and neck reconstructions were identified. Predictive accuracy was assessed using receiver operating characteristic curves (AUCs) and Brier scoring. Subgroup analyses stratified patients by procedure and hospital nationality. Interstudy heterogeneity was assessed with the I2 statistic.

Results: Nine studies totaling 1,774 patients were included. The SRC underpredicted the risk of all outcomes (including any complication [observed=35.9%, predicted=21.8%] and serious complication [ob=28.7%, pr=17.0%]) except mortality (ob=0.37%, pr=1.55%). Observed length of stay (LOS) was more than twice the predicted LOS (p < 0.02). The SRC showed acceptable discrimination only for post-operative pneumonia (AUC=0.778 [95% CI: 0.612,0.945]) and urinary tract infection (AUC=0.782 [95% CI: 0.672,0.983]). Predictive accuracy was low for all outcomes (Brier scores ≥0.01). In subgroup analyses Brier scores were higher overall for free flap reconstructions and international hospitals, and LOS predictions trended towards greater accuracy for free flap transfers (p=0.29) and US hospitals (p=0.07).

Conclusions: The NSQIP SRC is a flawed instrument for predicting outcomes in head and neck surgery, particularly when used internationally or for free flap transfers. Stratified analyses identified populations for whom the SRC is more effective and could inform development of a more accurate tool.