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Evaluation of the American College of Surgeons risk calculator in hepatectomy for metastatic colorectal cancer in a Southeast Asian population

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Abstract

Purpose

This study evaluated the accuracy of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) calculator in predicting outcomes after hepatectomy for colorectal cancer (CRC) liver metastasis in a Southeast Asian population.

Methods

Predicted and actual outcomes were compared for 166 patients undergoing hepatectomy for CRC liver metastasis identified between 2017 and 2022, using receiver operating characteristic curves with area under the curve (AUC) and Brier score.

Results

The ACS-NSQIP calculator accurately predicted most postoperative complications (AUC > 0.70), except for surgical site infection (AUC = 0.678, Brier score = 0.045). It also exhibited satisfactory performance for readmission (AUC = 0.818, Brier score = 0.011), reoperation (AUC = 0.945, Brier score = 0.002), and length of stay (LOS, AUC = 0.909). The predicted LOS was close to the actual LOS (5.9 vs. 5.0 days, P = 0.985).

Conclusion

The ACS-NSQIP calculator demonstrated generally accurate predictions for 30-day postoperative outcomes after hepatectomy for CRC liver metastasis in our patient population.

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Data availability

The data supporting this study’s findings are not publicly available due to privacy and ethical restrictions.

References

  1. Fong Y, Kemeny N, Paty P, et al (1996) Treatment of colorectal cancer: hepatic metastasisSeminars in surgical oncology, Wiley Online Library, 219–252. https://doi.org/10.1002/(SICI)1098-2388(199607/08)12:4<219::AID-SSU3>3.3.CO;2-O

  2. Adam R, Avisar E, Ariche A et al (2001) Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable colorectal [liver] metastases. Ann Surg Oncol 8:347–353

    Article  CAS  PubMed  Google Scholar 

  3. Scheele J, Stangl R, Altendorf-Hofmann A (1990) Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 77:1241–1246

    Article  CAS  PubMed  Google Scholar 

  4. Stangl R, Altendorf-Hofmann A, Charnley RM et al (1994) Factors influencing the natural history of colorectal liver metastases. The Lancet 343:1405–1410

    Article  CAS  Google Scholar 

  5. Jones NB, McNally ME, Malhotra L et al (2012) Repeat hepatectomy for metastatic colorectal cancer is safe but marginally effective. Ann Surg Oncol 19:2224–2229

    Article  PubMed  Google Scholar 

  6. Jarnagin WR, Gonen M, Fong Y et al (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kingham TP, Correa-Gallego C, D’Angelica MI et al (2015) Hepatic parenchymal preservation surgery: decreasing morbidity and mortality rates in 4,152 resections for malignancy. J Am Coll Surg 220:471–479

    Article  PubMed  Google Scholar 

  8. Mayo SC, Heckman JE, Shore AD et al (2011) Shifting trends in liver-directed management of patients with colorectal liver metastasis: a population-based analysis. Surgery 150:204–216

    Article  PubMed  Google Scholar 

  9. Mavros M, De Jong M, Dogeas E et al (2013) Impact of complications on long-term survival after resection of colorectal liver metastases. Journal of British Surgery 100:711–718

    Article  CAS  Google Scholar 

  10. Mayo SC, Pulitano C, Marques H et al (2013) Surgical management of patients with synchronous colorectal liver metastasis: a multicenter international analysis. J Am Coll Surg 216:707–716

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bilimoria KY, Liu Y, Paruch JL et al (2013) Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 217(833–842):e833

    Article  Google Scholar 

  12. Cohen ME, Bilimoria KY, Ko CY et al (2009) Development of an American College of Surgeons National Surgery Quality Improvement Program: morbidity and mortality risk calculator for colorectal surgery. J Am Coll Surg 208:1009–1016

    Article  PubMed  Google Scholar 

  13. Cohen ME, Liu Y, Ko CY et al (2017) An examination of American College of Surgeons NSQIP surgical risk calculator accuracy. J Am Coll Surg 224(787–795):e781

    Google Scholar 

  14. Liu JY, Sharma J (2021) Application of the ACS NSQIP surgical risk calculator on a global scale. The Am J Surg 222:876

    Article  PubMed  Google Scholar 

  15. Parkin CJ, Moritz P, Kirkland O et al (2021) What is the accuracy of the ACS-NSQIP surgical risk calculator in emergency abdominal surgery? A meta-analysis. J Surg Res 268:300–307

    Article  PubMed  Google Scholar 

  16. Alzahrani SM, Ko CS, Yoo M-W (2020) Validation of the ACS NSQIP surgical risk calculator for patients with early gastric cancer treated with laparoscopic gastrectomy. J Gastric Cancer 20:267

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hyde LZ, Valizadeh N, Al-Mazrou AM et al (2019) ACS-NSQIP risk calculator predicts cohort but not individual risk of complication following colorectal resection. The Am J Surg 218:131–135

    Article  PubMed  Google Scholar 

  18. Donadon M, Galvanin J, Branciforte B et al (2020) Assessment of the American College of Surgeons surgical risk calculator of outcomes after hepatectomy for liver tumors: Results from a cohort of 950 patients. Int J Surg 84:102–108

    Article  PubMed  Google Scholar 

  19. Strasberg S, Belghiti J, Clavien P-A et al (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339

    Article  Google Scholar 

  20. Tsoris A, Marlar CA (2019) Use of the Child Pugh score in liver disease

  21. Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724

    Article  PubMed  Google Scholar 

  22. Goh BK, Teo J-Y, Chan C-Y et al (2017) Evolution of laparoscopic liver resection at Singapore General Hospital: a nine-year experience of 195 consecutive resections. Singapore Med J 58:708

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hornor MA, Ma M, Zhou L et al (2020) Enhancing the American College of Surgeons NSQIP surgical risk calculator to predict geriatric outcomes. J Am Coll Surg 230(88–100):e101

    Google Scholar 

  24. Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36

    Article  CAS  PubMed  Google Scholar 

  25. Mandrekar JN (2010) Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol 5:1315–1316

    Article  PubMed  Google Scholar 

  26. EW S, (2010) Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology 21:128–138

    Article  Google Scholar 

  27. Rowell KS, Turrentine FE, Hutter MM et al (2007) Use of national surgical quality improvement program data as a catalyst for quality improvement. J Am Coll Surg 204:1293–1300

    Article  PubMed  Google Scholar 

  28. Beal EW, Lyon E, Kearney J et al (2017) Evaluating the American College of surgeons national surgical quality improvement project risk calculator: results from the US Extrahepatic biliary malignancy consortium. HPB 19:1104–1111

    Article  PubMed  Google Scholar 

  29. Sahara K, Paredes AZ, Merath K et al (2020) Evaluation of the ACS NSQIP surgical risk calculator in elderly patients undergoing hepatectomy for hepatocellular carcinoma. J Gastrointest Surg 24:551–559

    Article  PubMed  Google Scholar 

  30. Fruscione M, Kirks R, Cochran A et al (2018) Developing and validating a center-specific preoperative prediction calculator for risk of outcomes following major hepatectomy procedures. HPB 20:721–728

    Article  PubMed  Google Scholar 

  31. Merkow RP, Hall BL, Cohen ME et al (2012) Relevance of the c-statistic when evaluating risk-adjustment models in surgery. J Am Coll Surg 214:822–830

    Article  PubMed  Google Scholar 

  32. Zhou J, Sun H, Wang Z et al (2020) Guidelines for the diagnosis and treatment of hepatocellular carcinoma (2019 edition). Liver Cancer 9:682–720

    Article  PubMed  PubMed Central  Google Scholar 

  33. Alvarez FA, Claria RS, Oggero S et al (2016) Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases. World J Gastrointestinal Surg 8:407

    Article  Google Scholar 

  34. Richardson AJ, Pang TC, Johnston E et al (2013) The volume effect in liver surgery—a systematic review and meta-analysis. J Gastrointest Surg 17:1984–1996

    Article  PubMed  Google Scholar 

  35. Lu C-C, Chiu C-C, Wang J-J et al (2014) Volume-Outcome Associations after Major Hepatectomy for Hepatocellular Carcinoma: a Nationwide Taiwan Study. J Gastrointest Surg 18:1138–1145

    Article  PubMed  Google Scholar 

  36. Eppsteiner RW, Csikesz NG, Simons JP et al (2008) High volume and outcome after liver resection: surgeon or center? J Gastrointest Surg 12:1709–1716

    Article  PubMed  Google Scholar 

  37. Koh YX, Zhao Y, Tan IE-H et al (2023) The impact of hospital volume on liver resection: A systematic review and Bayesian network meta-analysis. Surgery 175:393–403. https://doi.org/10.1016/j.surg.2023.10.034

    Article  PubMed  Google Scholar 

  38. Lafaro K, Buettner S, Maqsood H et al (2015) Defining post hepatectomy liver insufficiency: where do we stand? J Gastrointest Surg 19:2079–2092

    Article  PubMed  Google Scholar 

  39. Gani F, Cerullo M, Amini N et al (2017) Frailty as a risk predictor of morbidity and mortality following liver surgery. J Gastrointest Surg 21:822–830

    Article  PubMed  Google Scholar 

  40. Kishida N, Hibi T, Itano O et al (2015) Validation of hepatectomy for elderly patients with hepatocellular carcinoma. Ann Surg Oncol 22:3094–3101

    Article  PubMed  Google Scholar 

  41. Louwers L, Schnickel G, Rubinfeld I (2016) Use of a simplified frailty index to predict Clavien 4 complications and mortality after hepatectomy: analysis of the National Surgical Quality Improvement Project database. The Am J Surg 211:1071–1076

    Article  PubMed  Google Scholar 

  42. Madsen HJ, Meguid RA, Bronsert MR et al (2022) Associations between preoperative risks of postoperative complications: Results of an analysis of 4.8 Million ACS-NSQIP patients. The Am J Surg 223:1172–1178

    Article  PubMed  Google Scholar 

  43. Mohanty S, Rosenthal RA, Russell MM et al (2016) Optimal perioperative management of the geriatric patient: a best practices guideline from the American College of Surgeons NSQIP and the American Geriatrics Society. J Am Coll Surg 222:930–947

    Article  PubMed  Google Scholar 

  44. Thanh NX, Baron T, Litvinchuk S (2019) An economic evaluation of the National surgical quality improvement program (NSQIP) in Alberta, Canada. Ann Surg 269:866–872

    Article  PubMed  Google Scholar 

  45. Nimeri AA, Bautista J, Philip R (2019) Reducing healthcare costs using ACS NSQIP-driven quality improvement projects: A success story from Sheikh Khalifa Medical City (SKMC). World J Surg 43:331–338

    Article  PubMed  Google Scholar 

  46. Tan EJKW, Chen HLR, Chok AY et al (2023) A reduction in hospital length of stay reduces costs for colorectal surgery: an economic evaluation of the National Surgical Quality Improvement Program in Singapore. Int J Colorectal Dis 38:257

    Article  PubMed  Google Scholar 

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Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, 20 College Road, Singapore, 169856, Singapore

    Ye Xin Koh, Hwee Leong Tan, Darren Weiquan Chua, Wei-Liang Loh, Ek Khoon Tan, Jin Yao Teo & Brian Kim Poh Goh

  2. Duke-National University of Singapore Medical School, Singapore, Singapore

    Ye Xin Koh, Hwee Leong Tan, Darren Weiquan Chua, Wei-Liang Loh, Ek Khoon Tan, Jin Yao Teo & Brian Kim Poh Goh

  3. Liver Transplant Service, SingHealth Duke-National University of Singapore Transplant Centre, Singapore, Singapore

    Ye Xin Koh, Darren Weiquan Chua, Ek Khoon Tan & Brian Kim Poh Goh

  4. Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore

    Ivan En-Howe Tan, Yun Zhao, Hui Min Chong, Boon Hwee Ang & Marianne Kit Har Au

  5. Finance, SingHealth Community Hospitals, Singapore, 168582, Singapore

    Marianne Kit Har Au

  6. Finance, Regional Health System & Strategic Finance, Singapore Health Services, Singapore, 168582, Singapore

    Marianne Kit Har Au

Authors
  1. Ye Xin Koh
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Contributions

Conceptualization: Ye Xin Koh, Yun Zhao.

Methodology: Ye Xin Koh, Ivan En-Howe Tan, Yun Zhao.

Software: Yun Zhao, Hui Min Chong, Boon Hwee Ang.

Validation: Ye Xin Koh, Ivan En-Howe Tan, Hwee Leong Tan, Darren Weiquan Chua, Wei-Liang Loh.

Formal analysis: Yun Zhao, Hui Min Chong, Boon Hwee Ang.

Investigation: Ye Xin Koh, Hwee Leong Tan, Darren Weiquan Chua, Wei-Liang Loh, Ek Khoon Tan, Jin Yao Teo.

Resources: Ivan En-Howe Tan, Marianne Kit Har Au, Brian Kim Poh Goh.

Data curation: Hui Min Chong, Boon Hwee Ang.

Writing – Original Draft: Ye Xin Koh, Ivan En-Howe Tan, Yun Zhao.

Writing – Review & Editing: all authors.

Visualization: Yun Zhao, Boon Hwee Ang.

Supervision: Marianne Kit Har Au, Brian Kim Poh Goh.

Project administration: Ek Khoon Tan, Jin Yao Teo, Brian Kim Poh Goh.

All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Ye Xin Koh.

Ethics declarations

Competing interests

The authors declare no competing interests.

Conflicts of interest/Competing interests

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethics approval

This study was approved by Singapore Health Services (SingHealth) Institutional Review Board (IRB Ref. 2023/2762). Due to the study's retrospective design using de-identified data, written informed consent collection was waived by SingHealth Centralised Institutional Review Board D. All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki).

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Koh, Y.X., Tan, I.EH., Zhao, Y. et al. Evaluation of the American College of Surgeons risk calculator in hepatectomy for metastatic colorectal cancer in a Southeast Asian population. Langenbecks Arch Surg 409, 152 (2024). https://doi.org/10.1007/s00423-024-03331-x

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  • DOI: https://doi.org/10.1007/s00423-024-03331-x

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