The American College of Surgeon National Surgical Quality Improvement Program risk calculator does not predict individual outcomes in an elderly Italian population.

Background: Elderly population has an increased risk of post-operative complications, therefore a precise and quick assessment of the expected risks allows a more aware decision on surgical indications. The American College of Surgeons NSQIP Surgical Risk Calculator (ACS-NSQIP SRC) is a practical tool that provides estimates of outcomes, however previous studies showed heterogeneous results. Our aim was to test its ability to correctly predict post-operative complications in a cohort of elderly patients who underwent major surgery in our Institution.

Methods: Data on consecutive elderly patients (≥75 years) that underwent major surgery (2022-2023) were retrospectively collected. The SRC was queried and the risk of post-operative complications, including geriatric outcomes, was obtained. Patients were divided into four groups based on CPT code. Observed and expected complication rates were compared.

Results: A total of 112 patients (50.9% female, median age 80 years, median BMI 28.8 kg/m²) were included and divided into groups (urgent 60 patients, colorectal 20, upper-GI resections 17 and benign upper-GI 15). In the urgent group, we observed a higher rate of serious complications (22 vs. 12.7, P=0.005), any complications (30 vs. 15.6, P<0.001) and superficial SSI (17 vs. 4.9, P<0.001) than the expected. Discharge to post-acute care facilities was over-estimated.

Conclusions: The ACS-NSQIP SRC demonstrated poor ability to predict post-operative complications and geriatric outcomes in our cohort of elderly patients. Our findings confirm other studies that temper the enthusiasm towards the NSQIP SRC as a practical tool to predict post-operative complications, especially in an urgent setting.