Work

External validation of the ACS NSQIP surgical risk calculator for the prediction of surgical site infection (SSI) and its association with the postoperative occurrence of incisional hernia (IH) in midline laparotomy patients

Year: 2025

Type: article

Abstract: PURPOSE: Incisional hernia (IH) is a common complication following midline laparotomy, with an incidence of 12.8% at 23.8 months of follow-up. Surgical site infection (SSI) is a significant risk factor for IH. The ACS NSQIP Surgical Risk Calculator is a widely used tool for predicting postoperative complications, including SSI. This study aims to externally validate this calculator in a population of patients undergoing midline laparotomy. METHODS: A retrospective longitudinal study was conducted on 1083 patients who underwent midline laparotomy between January 2015 and November 2022. The ability of the ACS NSQIP calculator to predict SSI and its association with the occurrence of IH was evaluated. RESULTS: The incidence of SSI was 13.21%. The ACS NSQIP calculator demonstrated good discriminative ability (AUC 0.88) and calibration (Brier score 0.072) for predicting SSI. An optimal cutoff point of 6.6 was identified, with a sensitivity of 78% and specificity of 92%. The presence of SSI increased the risk of IH by a factor of 6 (OR 5.9, 95% CI 3.4-10.3). CONCLUSIONS: The ACS NSQIP Surgical Risk Calculator is a valid tool for predicting SSI in patients undergoing midline laparotomy, with good discriminative ability and calibration. SSI is a significant risk factor for the occurrence of IH, suggesting that including this variable in IH prediction scales could improve their accuracy.

Source: Langenbeck s Archives of Surgery

DOI: 10.1007/s00423-025-03807-4