World J Surg Surg Res | Volume 5, Issue 1 | Research Article | Open Access

ACS-NSQIP-Surgical Risk Calculator Accurately Predicts Outcomes of Laparotomy in a Prospective Study at a Tertiary Hospital in Tanzania

Kagaruki TB1*, Kivuyo NE2, Mushi FA2, Muhamba FD2 and Akoko LO1

1Department of Surgery, Muhimbili University of Health and Allied Science, Tanzania
2Department of General Surgery, Muhimbili National Hospital, Tanzania

*Correspondance to: Tryphone Buchard Kagaruki 

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Introduction: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator is excellent in predicting postoperative complications. Validation in resource-limited settings and applicability in gastrointestinal surgery is still unclear. Objective: The study aimed to determine the accuracy of the ACS-NSQIP surgical risk calculator in predicting the 30 days postoperative adverse outcomes among patients who underwent laparotomy. Methods: A single hospital-based, prospective cohort study done at Muhimbili National Hospital in Tanzania from April 2021 to December 2021 recruiting patients aged 18 and above who underwent primary laparotomy. SR calculator variables were obtained from patients and entered manually to categorize patients into low and high risk. Patients were followed up for thirty days for outcome. The predicted risk was compared with actual occurrence to obtain personal risk ratios. The c-statistics of >0.7, Brier of score <0.25, and index of prediction accuracy score were used for discrimination, accuracy and usefulness of the model respectively. Results: ACS-NSQIP SR-Calculator discriminated well the risks of cardiac complications, relaparotomy, Anastomotic leak, and death (c-statistic >0.7) Poor discrimination was observed for the length of hospital stay (c-statistics 0.518). However, SR-calculator shows high calibration potential for all complications with Brier score <0.25 (0.002-0.144) and IPA score ranging from 0.225-0.969. Conclusion: The ACS -NSQIP SR-calculator accurately predicted postoperative outcomes for patients requiring laparotomy. SR-Calculator is a reliable tool for preoperative shared decisionmaking and counseling. The model should be adopted to strengthen the health care system in the low-income country.


ACS-NSQIP-SR calculator; Primary laparotomy; A severe complication


Kagaruki TB, Kivuyo NE, Mushi FA, Muhamba FD, Akoko LO. ACS-NSQIPSurgical Risk Calculator Accurately Predicts Outcomes of Laparotomy in a Prospective Study at a Tertiary Hospital in Tanzania. World J Surg Surgical Res. 2022; 5: 1425..

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