Accuracy of the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program risk/benefit calculator in predicting outcomes of revisional bariatric surgery.
Qais AbuHasan, Bogdana Chesnova, Diala Sanduka, Sara Saeidi, Wentao Chang, Tarik K Yuce, Dimitrios Stefanidis
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引用次数: 0
Abstract
Background: The Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) risk/benefit calculator is an important tool used to counsel patients and predict postoperative risk and outcomes after bariatric surgery.
Objectives: We aimed to assess the accuracy of the calculator in predicting outcomes after revisional bariatric procedures compared with primary procedures.
Setting: Single-institution and national data.
Methods: Postoperative outcomes (30-day complications and body mass index [BMI] at 6 months and 1 year) of patients undergoing primary and revisional bariatric procedures between 2016 and 2021 were recorded and compared with the predictions of the online calculator. Receiver operating characteristic curves were constructed to assess the predictive utility for binominal outcomes. For BMI, predictive error (predicted - actual BMI) was calculated. We also queried the MBSAQIP participant use files between 2021 and 2022 to examine the calculator use nationally.
Results: Out of 1026 patients, 864 (84.2%) had primary, and 162 (15.8%) had revisional bariatric surgery. The area under the curve for any complication, serious complications, surgical site infections (SSIs), and readmissions were .63, .74, .67, and .52 for primary procedures, and .61, .73, .52, and .57 for revisions. The correlation coefficient of predicted and observed 1-year BMI was .74, P < .001 for primary procedures, and .55, P < .001 for revisions. The mean predictive error for 1-year BMI for revisions was higher than that for primary procedures (-3.8 ± 5.2 vs. -.30 ± 4.3, P < .001) with 75% of revisions having a negative predictive error. At the national level, the calculator was used in 18.4% of primary procedures and 16.1% (P < .001) of revisions.
Conclusions: The MBSAQIP calculator is being used to counsel patients undergoing primary and revisional bariatric surgery. While calculator predictions for some outcomes are similar between primary and revisional cases, they are inaccurate for SSIs and weight loss outcomes after revisional surgeries. The development of a revision-specific calculator that provides more accurate estimates is recommended.
背景：代谢和减肥手术认证质量改进计划（MBSAQIP）风险/收益计算器是一个重要的工具，用于咨询患者和预测减肥手术后的术后风险和结果。目的：我们的目的是评估计算器在预测修正减肥手术后与原手术后结果的准确性。设置：单一机构和国家数据。方法：记录2016年至2021年间接受原发性和改改性减肥手术的患者的术后结果（30天并发症和6个月和1年的体重指数[BMI]），并与在线计算器的预测结果进行比较。构建受试者工作特征曲线以评估二项结果的预测效用。对于BMI，计算预测误差（预测-实际BMI）。我们还查询了MBSAQIP参与者在2021年至2022年之间的使用文件，以检查计算器在全国的使用情况。结果：在1026例患者中，864例（84.2%）进行了原发性减肥手术，162例（15.8%）进行了修正性减肥手术。任何并发症、严重并发症、手术部位感染（ssi）和再入院的曲线下面积为。63年,。74年,。67、和。52为初级程序，和。61年,。73年,。52，和。57进行修订。预测与观测的1年BMI相关系数为。74, P < 0.001。55, P < 0.001。修订后1年BMI的平均预测误差高于原手术（-3.8±5.2 vs - 0.30±4.3,P < 0.001）， 75%的修订具有负预测误差。在国家一级，18.4%的初级手术使用计算器，16.1%的修订手术使用计算器（P < 0.001）。结论：MBSAQIP计算器可用于为接受原发性和改进性减肥手术的患者提供咨询。虽然计算器预测的一些结果在原发病例和修复病例之间是相似的，但对于修复手术后的ssi和体重减轻结果是不准确的。建议开发特定于修订的计算器，以提供更准确的估计。
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