Journal of the American College of Surgeons
-
The American College of Surgeons NSQIP risk calculator was developed from multi-institutional clinical data to estimate preoperative risk. The impact of outliers has the potential to greatly affect predictions. Although the effect of outliers is minimized in large series, their impact on the individual provider or institution could be profound. No previous study has assessed the risk calculator for a single institution or provider, including outliers. Our goal was to evaluate the accuracy of the predicted outcomes at a single institution. ⋯ Although the risk calculator was effective for evaluating average surgical-risk patients, it does not accurately predict outcomes in a small percentage of patients when one or more serious complications occur. Addition of surgeon- and patient-specific data via the American College of Surgeons case-logging system could better adjust for these areas.
-
Texture analysis is a promising method of analyzing imaging data to potentially enhance diagnostic capability. This approach involves automated measurement of pixel intensity variation that may offer further insight into disease progression than do standard imaging techniques alone. We postulated that postoperative liver insufficiency, a major source of morbidity and mortality, correlates with preoperative heterogeneous parenchymal enhancement that can be quantified with texture analysis of cross-sectional imaging. ⋯ In this preliminary study, the texture of liver parenchyma on preoperative CT was significantly more varied, less symmetric, and less homogeneous in patients with postoperative liver insufficiency. Therefore, texture analysis has the potential to provide an additional means of preoperative risk stratification.