The American College of Surgeon's surgical risk calculator's ability to predict disposition in older gynecologic oncology patients undergoing laparotomy

Objectives: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator calculates risk of postoperative complications utilizing clinically apparent preoperative variables. If validated for patients with gynecologic cancers, this can be an effective tool in to use for shared decision-making, especially in the older (70+ years of age) patient population for whom surgical risks and potential loss of independence is increased. The primary objective of this study was to evaluate the ability of the ACS NSQIP surgical risk calculator to predict discharge to a post-acute care among older (age 70+ years) gynecologic oncology patients undergoing laparotomy. The secondary objectives were to assess its ability to predict postoperative complications and death. Methods: This was a retrospective cohort study of gynecologic oncology patients 70+ years of age undergoing laparotomy. Surgical procedures, 21 preoperative variables, postoperative complications, and patient disposition were abstracted from the medical record. Risk scores for seven postoperative complications and discharge to post-acute care were calculated. The association between risk scores and outcomes were assessed using logistic regression and predictive ability was evaluated using the c-statistic and Brier score. Results: 204 surgeries were performed on 200 patients between January 1, 2009 and December 31, 2013. The mean age was 76.3 +/- 5.1 years; 87% were independent at baseline. A total of 79 (41%) were discharged to post-acute care. The calculator's ability to predict discharge to post-acute care was reasonable (c- statistic = 0.708, Brier = 0.205). Although the calculator did not accurately predict all postoperative complications, the calculator's ability to predict death was strong (c-statistic = 0.811, Brier = 0.015). Conclusion: For older patients with an elevated calculated risk of discharge to post acute care the possibility of discharge to post-acute care should be discussed preoperatively. For patients with a higher risk of death, nonsurgical management options should be considered when available. (C) 2019 Elsevier Ltd. All rights reserved.