Estimation of Risk in Cancer Patients Undergoing Palliative Procedures by the American College of Surgeons Risk Calculator.

Background: Surgical palliation is defined as the use of a procedure to relieve symptoms. The American College of Surgeons Risk Calculator (ACSRC) was created based on data from the National Surgical Quality Improvement Program to predict the risk of surgical complications on a patient-specific level. Whether the ACSRC can accurately predict the risk of postoperative complications following palliative procedures in cancer patients is unknown. The purpose of this study was to determine if the ACSRC accurately predicted postoperative complication rates in this setting.

Study Design: A prospectively maintained, surgical oncology database of patient outcomes from 2011 to 2013 was queried. Data extracted included the following: demographics, comorbidities, site and stage of cancer, type of procedure, and post-operative complication rate and type. Risk assessment was performed for each patient using the ACSRC. Predicted outcomes were compared to actual outcomes for length of stay (LOS), complications, and death. Main outcome measures were differences in actual versus predicted outcomes.

Results: Thirty-two patients were included. Occurrence of any complication was significantly lower than predicted (31% vs. 59%, p < 0.05). The predicted LOS, however, was 2.9 days; significantly lower than 5.4 days (p < 0.05).

Conclusion: The ACSRC is a powerful tool for aid in surgical decision-making; however, in the case of palliative procedures for cancer patients, it overestimated the risk of postoperative complications and underestimated the LOS. Overestimation of post-operative complications could result in fewer patients being offered potentially beneficial palliative procedures.