Evaluation of the American College of Surgeons Surgical Risk Calculator in older adults undergoing gastrointestinal cancer surgery: a retrospective chart review study.

INTRODUCTION: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Risk Calculator estimates surgical and geriatric outcomes for operations. However, the predictive accuracy in older adults undergoing gastrointestinal cancer surgery is unclear. The purpose of this study was to evaluate the predictive characteristics of the ACS NSQIP Risk Calculator, including geriatric outcomes, in older adults who undergo gastrointestinal cancer surgery. MATERIALS AND METHODS: This was a retrospective study of older patients aged ≥ 70 years who received gastrointestinal cancer surgery at St Michael's Hospital (Toronto, Canada) between July 1, 2020 and October 5, 2023. A total of 106 patients were included for analysis (mean age 79.5 years, 41.5% female). RESULTS: The ACS NSQIP calculator demonstrated good overall predictive performance for 30-day mortality (Brier score 0.036 [cutoff 0.039]), 30-day readmission (Brier score 0.070 [cutoff 0.147]), discharge to rehabilitation or LTC (Brier score 0.099 [cutoff 0.146]), functional decline (Brier score 0.155 [cutoff 0.250]), and new mobility aid use (Brier score 0.141 [cutoff 0.249]). The calculator had low overall predictive performance for any complication (Brier score 0.166 [cutoff 0.145]), serious complication (Brier score 0.135 [cutoff 0.134], delirium (Brier score 0.160 [cutoff 0.133], or pressure ulcer (Brier score 0.031 [cutoff 0.006]). CONCLUSION: In older adults with surgical management of gastrointestinal cancer, the NSQIP surgical risk calculator may be used to predict several surgical and geriatric outcomes, including discharge to rehabilitation or LTC, functional decline, and new mobility aid use, but not surgical complication or delirium.