The Non-Operability Risk Score from ACS-NSQIP outputs predicted multidisciplinary non-operability decisions with strong accuracy (AUC = 0.805, p < 0.001).
Does the ACS-NSQIP Surgical Risk Calculator and derived Non-Operability Risk Score accurately reflect multidisciplinary operability decisions in complex surgical patients?
The ACS-NSQIP derived Non-Operability Risk Score strongly correlates with multidisciplinary operability decisions, providing a standardized tool for preoperative assessment in complex surgical patients.
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BACKGROUND: Complex surgical patients (CSP) often present with frailty, comorbidities, and limited physiological reserve, making operability decisions highly challenging. We hypothesized that parameters derived from the ACS National Surgical Quality Improvement Program (ACS-NSQIP) Surgical Risk Calculator could reflect multidisciplinary assessments of operability and support preoperative decision-making in this population. STUDY DESIGN: A single-center prospective observational cohort study included 134 consecutive complex surgical patients evaluated by a multidisciplinary committee between November 2022 and April 2025. All patients underwent standardized preoperative assessment, including ACS-NSQIP estimation, but operability decisions were made independently of the ACS-NSQIP results. The primary endpoint was the ability of the NSQIP-derived Risk Deviation to discriminate between operable and non-operable patients. This variable was analyzed using ROC curves, and findings were used to develop a Non-Operability Risk Score. RESULTS: Of the 134 patients, 98 (73.1%) were evaluated as operable and 35 (26.1%) as non-operable. The “Risk Deviation” variable showed moderate to good discriminatory power (AUC range: 0.678–0.740, all p<0.01) for outcomes such as serious complications, readmission, or death. The Non-Operability Risk Score, derived from six ACS-NSQIP outputs, correlated strongly with the committee’s operability decisions (AUC = 0.805, p<0.001) and demonstrated a significant trend: higher scores were associated with increased likelihood of non-operability. Among the 80 patients who underwent surgery, complication rates did not correlate with the Non-Operability Risk Score. CONCLUSIONS: ACS-NSQIP and particularly the derived Non-Operability Risk Score are useful tools to support multidisciplinary operability decisions in complex surgical patients. Their use may help standardize preoperative discussions, though further multicenter validation is needed to confirm generalizability.
Pavel et al. (Thu,) reported a other. The Non-Operability Risk Score from ACS-NSQIP outputs predicted multidisciplinary non-operability decisions with strong accuracy (AUC = 0.805, p < 0.001).