Validation of the ACS-NSQIP surgical risk calculator for patients with paraoesophageal hernias undergoing robotic repair.

Abstract

<h4>Background</h4>The National Surgical Quality Improvement Program (NSQIP) American College of Surgeons (ACS) risk calculator is a validated method of predicting postoperative complications that was recently updated to a machine-learning structure. The objective of this study was to measure the accuracy of this calculator in our institution on paraoesophageal hernia (PEH) repair.<h4>Method</h4>Procedures performed between 2019 and 2023 were retrospectively collected regarding demographics, operative variables, and outcomes with a 30-day follow-up. Thirteen outcomes measured by NSQIP-ACS calculator were measured. Observed and predicted rates were compared by receiver operating curves (ROC) and length of stay was compared by Wilcoxon signed rank test.<h4>Results</h4>A total of 203 paraoesophageal hernia repairs on patients with a median age of 68 (IQR 61-75) and 70.9% (n = 144) predominantly female. The size of the paraoesophageal hernia (PEH) was large or giant in 59.1% (n = 120) and mesh was placed in 70.4% (n = 143). The predicted risk was consistently higher than observed events on all but discharge destinations. Eight outcomes had no event to measure; however, the calculator accurately predicted a risk of ≤ 1% on all of these. The area under the curve (AUC) was fair (0.6-0.79) on discharge to nursing or rehabilitation facilities and failed in the rest of the measurable outcomes.<h4>Conclusion</h4>The ACS-NSQIP risk calculator correctly predicted a low occurrence of postoperative outcomes in patients undergoing robotic paraoesophageal hernia repair.