Ability of the National Surgical Quality Improvement Program Risk Calculator to Predict Complications Following Total Laryngectomy | Facial Plastic Surgery | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Investigation
October 2016

Ability of the National Surgical Quality Improvement Program Risk Calculator to Predict Complications Following Total Laryngectomy

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
  • 3Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana
  • 4Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
  • 5Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
JAMA Otolaryngol Head Neck Surg. 2016;142(10):972-979. doi:10.1001/jamaoto.2016.1809
Key Points

Question  Does the National Surgical Quality Improvement Program (NSQIP) calculator reliably predict complications in patients undergoing laryngectomy?

Finding  This study found that the calculator had limited utility in predicting postoperative pneumonia, surgical site infection, return to operating room, and venous thromboembolism, with few exceptions.

Meaning  There are a number of factors in the laryngectomy population that make the NSQIP calculator less reliable in this group of patients.


Importance  The accuracy of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) risk calculator has been assessed in multiple surgical subspecialties; however, there have been no publications doing the same in the head and neck surgery literature.

Objective  To evaluate the accuracy of the calculator’s predictions in a single institution’s total laryngectomy (TL) population.

Design, Setting, and Participants  Total laryngectomies performed between 2013 and 2014 at a tertiary referral academic center were evaluated using the risk calculator. Predicted 30-day outcomes were compared with observed outcomes for return to operating room, surgical site infection, postoperative pneumonia, length of stay, and venous thromboembolism.

Main Outcomes and Measures  Comparison of the NSQIP risk calculator’s predicted postoperative complication rates and length of stay to what occurred in this patient cohort using percent error, Brier scores, area under the receiver operating characteristic curve, and Pearson correlation analysis.

Results  Of 49 patients undergoing TL, the mean (SD) age at operation was 59 (9.3) years, with 67% male. The risk calculator had limited efficacy predicting perioperative complications in this group of patients undergoing TL with or without free tissue reconstruction or preoperative chemoradiation or radiation therapy with a few exceptions. The calculator overestimated the occurrence of pneumonia by 165%, but underestimated surgical site infection by 7%, return to operating room by 24%, and length of stay by 13%. The calculator had good sensitivity and specificity of predicting surgical site infection for patients undergoing TL with free flap reconstruction (area under the curve, 0.83). For all other subgroups, however, the calculator had poor sensitivity and specificity for predicting complications.

Conclusions and Relevance  The risk calculator has limited utility for predicting perioperative complications in patients undergoing TL. This is likely due to the complexity of the treatment of patients with head and neck cancer and factors not taken into account when calculating a patient’s risk.