Abstract：
BACKGROUND: The National Surgical Quality Improvement Program surgical risk calculator (SRC) estimates the risk for postoperative complications. This meta-analysis assesses the efficacy of the SRC in the field of head and neck surgery.
METHODS: A systematic review identified studies comparing the SRC\'s predictions to observed outcomes following head and neck surgeries. Predictive accuracy was assessed using receiver operating characteristic curves (AUCs) and Brier scoring.
RESULTS: Nine studies totaling 1774 patients were included. The SRC underpredicted the risk of all outcomes (including any complication [observed (ob) = 35.9%, predicted (pr) = 21.8%] and serious complication [ob = 28.7%, pr = 17.0%]) except mortality (ob = 0.37%, pr = 1.55%). The observed length of stay was more than twice the predicted length (p < 0.02). Discrimination was acceptable for postoperative pneumonia (AUC = 0.778) and urinary tract infection (AUC = 0.782) only. Predictive accuracy was low for all outcomes (Brier scores ≥0.01) and comparable for patients with and without free-flap reconstructions.
CONCLUSIONS: The SRC is an ineffective instrument for predicting outcomes in head and neck surgery.
METHODS: A systematic review identified studies comparing the SRC\'s predictions to observed outcomes following head and neck surgeries. Predictive accuracy was assessed using receiver operating characteristic curves (AUCs) and Brier scoring.
RESULTS: Nine studies totaling 1774 patients were included. The SRC underpredicted the risk of all outcomes (including any complication [observed (ob) = 35.9%, predicted (pr) = 21.8%] and serious complication [ob = 28.7%, pr = 17.0%]) except mortality (ob = 0.37%, pr = 1.55%). The observed length of stay was more than twice the predicted length (p < 0.02). Discrimination was acceptable for postoperative pneumonia (AUC = 0.778) and urinary tract infection (AUC = 0.782) only. Predictive accuracy was low for all outcomes (Brier scores ≥0.01) and comparable for patients with and without free-flap reconstructions.
CONCLUSIONS: The SRC is an ineffective instrument for predicting outcomes in head and neck surgery.
摘要：
背景：国家手术质量改进计划手术风险计算器（SRC）估计了术后并发症的风险。这项荟萃分析评估了SRC在头颈部手术领域的疗效。
方法：一项系统评价确定了将SRC的预测与头颈部手术后观察到的结果进行比较的研究。使用受试者工作特征曲线(AUC)和Brier评分评估预测准确性。
结果：纳入9项研究，共1774名患者。SRC低估了所有结局的风险（包括任何并发症[观察（ob）=35.9%，预测（pr）=21.8%]和严重并发症[ob=28.7%，pr=17.0%])，除了死亡率(ob=0.37%，pr=1.55%）。观察到的停留时间是预测长度的两倍以上(p<0.02)。仅对术后肺炎（AUC=0.778）和尿路感染（AUC=0.782）进行区分是可以接受的。所有结果的预测准确性都很低（Brier评分≥0.01），并且对于有和没有游离皮瓣重建的患者具有可比性。
结论：SRC是预测头颈部手术结果的无效工具。
方法：一项系统评价确定了将SRC的预测与头颈部手术后观察到的结果进行比较的研究。使用受试者工作特征曲线(AUC)和Brier评分评估预测准确性。
结果：纳入9项研究，共1774名患者。SRC低估了所有结局的风险（包括任何并发症[观察（ob）=35.9%，预测（pr）=21.8%]和严重并发症[ob=28.7%，pr=17.0%])，除了死亡率(ob=0.37%，pr=1.55%）。观察到的停留时间是预测长度的两倍以上(p<0.02)。仅对术后肺炎（AUC=0.778）和尿路感染（AUC=0.782）进行区分是可以接受的。所有结果的预测准确性都很低（Brier评分≥0.01），并且对于有和没有游离皮瓣重建的患者具有可比性。
结论：SRC是预测头颈部手术结果的无效工具。
