Application of the ACS NSQIP Surgical Risk Calculator on a global scale

The American College of Surgeons (ACS) NSQIP Surgical Risk Calculator (SRC) has been a valuable tool in the United States to predict postoperative outcomes in patients. 1 Bilimoria K.Y. Liu Y. Paruch J.L. et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013; 217 (e831-833): 833-842 Abstract Full Text Full Text PDF PubMed Scopus (884) Google Scholar ,2 Liu Y. Cohen M.E. Hall B.L. Ko C.Y. Bilimoria K.Y. Evaluation and enhancement of calibration in the American College of surgeons NSQIP surgical risk calculator. J Am Coll Surg. 2016; 223: 231-239 Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar Its use of a robust predictor set and adjustment for procedure complexity through current procedural terminology (CPT) code allows surgeons to utilize multi-institutional clinical data to estimate risks and facilitate discussions of these risks to assist with clinical decision making between patients, caregivers, and clinicians. In this issue of American Journal of Surgery, Ma et al. 3 Ma M. Liu Y. Gotoh M. et al. Validation study of the ACS NSQIP surgical risk calculator for two procedures in Japan. Am J Surg. 2021; Abstract Full Text Full Text PDF Scopus (2) Google Scholar collaborated with Japanese surgeons to evaluate the applicability of the SRC to predict 30-day mortality of two complex operations (low anterior resection and pancreaticoduodenectomy) in Japan using data from the Japanese National Clinical Database (NCD). They found that the SRC did not perform well when applied without changes to the NCD data, however they provide a simple calculation to determine a correction factor for intercept adjustment that significantly improved the calibration of the risk calculator, significantly improving its overall applicability.