AUA 2017: National surgical quality improvement program surgical risk calculator poorly predicts complications in patients undergoing radical cystectomy with urinary diversion: the case for a procedure-specific risk calculator

Boston, MA ( Dr. Adamsky and colleagues presented on the American College of Surgeons and National Surgical Quality Improvement Program (NSQIP) Risk Calculator. They felt the risk profile generated and use to help a patient understand the possible morbidity and mortality associated with surgeries may not adequately characterize the risks associated with radical cystectomy and urinary diversion. The objective of this study was to evaluate the accuracy of this NSQIP risk calculator in patients undergoing radical cystectomy with urinary diversion. They reviewed 5 years of radical cystectomy data and used Brier scores as a measure of NSQIP calculator accuracy. Over 560 patients were included. The length of stay was underestimated as well as serious complications. For patients whom had neobladders the calculator performed slightly better. They concluded that the NSQUIP calculator poorly predicted the actual clinical outcomes of cystectomy patients.

The better neobladder prediction could have had inherent selection bias given things such as renal function are factored into both the decision to perform and neobladder and the calculator. For patients who are undergoing radical cystectomy with urinary diversion, complications for this procedure are not accurately predicted by the NSQIP risk calculator. The moderator interestingly commented that their group had found similar discrepancies in partial nephrectomy patients. In order to accurately describe outcomes as a field and to set quality measures we must as a field be able to accurately predict and describe outcomes.

Presented By: Melanie Adamsky

Written By: Janet Baack Kukreja (@janetkukreja), MD, MPH, Urologic Oncology Fellow, Department of Urology, UT MD Anderson Cancer Center, Houston, TX, Ashish M. Kamat, MD, MBBS, FACS, Wayne B. Duddlesten Professor, Department of Urology, UT MD Anderson Cancer Center, Houston TX

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA