Skip to main content Accessibility help

Validity of the American College of Surgeons' National Surgical Quality Improvement Program risk calculator in South Australian glossectomy patients

  • S S Kao (a1), C Frauenfelder (a1), D Wong (a1), S Edwards (a2), S Krishnan (a3) and E H Ooi (a1) (a4)...



Appropriate selection of tongue cancer patients considering surgery is critical in ensuring optimal outcomes. The American College of Surgeons' National Surgical Quality Improvement Program (‘ACS-NSQIP’) risk calculator was developed to assess patients' 30-day post-operative risk, providing surgeons with information to guide decision making.


A retrospective review of 30-day actual mortality and morbidity of tongue cancer patients was undertaken to investigate the validity of this tool for South Australian patients treated from 2005 to 2015.


One hundred and twenty patients had undergone glossectomy. Predicted length of stay using the risk calculator was significantly different from actual length of stay. Predicted mortality and other complications were found to be similar to actual outcomes.


The American College of Surgeons' National Surgical Quality Improvement Program risk calculator was found to be effective in predicting post-operative complication rates in South Australian tongue cancer patients. However, significant discrepancies in predicted and actual length of stay may limit its use in this population.


Corresponding author

Address for correspondence: Dr Stephen Shih-Teng Kao, ENT Head and Neck Surgery, Flinders Medical Centre, Flinders Dr, Bedford Park, SA 5042, Australia E-mail:


Hide All

Presented orally at the 13th Japan-Taiwan Conference on Otolaryngology Head and Neck Surgery Meeting, 3–4 December 2015, Tokyo, Japan.



Hide All
1 Khuri, SF, Daley, J, Henderson, W, Hur, K, Demakis, J, Aust, JB et al. The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 1998;228:491507
2 Stachler, RJ, Yaremchuk, K, Ritz, J. Preliminary NSQIP results: a tool for quality improvement. Otolaryngol Head Neck Surg 2010;143:2630, e1–3
3 Ferlay, J, Shin, HR, Bray, F, Forman, D, Mathers, C, Parkin, DM. GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. Lyon: International Agency for Research on Cancer, 2010
4 Chaturvedi, AK, Anderson, WF, Lortet-Tieulent, J, Curado, MP, Ferlay, J, Franceschi, S et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. J Clin Oncol 2013;31:4550–9
5 Carvalho, AL, Nishimoto, IN, Califano, JA, Kowalski, LP. Trends in incidence and prognosis for head and neck cancer in the United States: a site-specific analysis of the SEER database. Int J Cancer 2005;114:806–16
6 Bilimoria, KY, Liu, Y, Paruch, JL, Zhou, L, Kmiecik, TE, Ko, CY et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 2013;217:833–42, e1–3
7 Chen, MM, Roman, SA, Sosa, JA, Judson, BL. Postdischarge complications predict reoperation and mortality after otolaryngologic surgery. Otolaryngol Head Neck Surg 2013;149:865–72
8 Russell, PT, Hakendorf, P, Thompson, CH. A general medical short-stay unit is not more efficient than a traditional model of care. Med J Aust 2014;200:482–4
9 Australian Institute of Health and Welfare 2016. Hospital performance: relative stay index. In: [17 February 2016]
10 Brier, GW. Verification of forecasts expressed in terms of probability. Monthly Weather Review 1950;78:13
11 Steyerberg, EW, Vickers, AJ, Cook, NR, Gerds, T, Gonen, M, Obuchowski, N et al. Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology 2010;21:128–38
12 Downey, RJ, Friedlander, P, Groeger, J, Kraus, D, Schantz, S, Spiro, R et al. Critical care for the severely ill head and neck patient. Crit Care Med 1999;27:95–7
13 de Melo, GM, Ribeiro, KC, Kowalski, LP, Deheinzelin, D. Risk factors for postoperative complications in oral cancer and their prognostic implications. Arch Otolaryngol Head Neck Surg 2001;127:828–33
14 Lewis, CM, Aloia, TA, Shi, W, Martin, I, Lai, SY, Selber, JC et al. Development and feasibility of a specialty-specific National Surgical Quality Improvement Program (NSQIP): the head and neck-reconstructive surgery NSQIP. JAMA Otolaryngol Head Neck Surg 2016;142:321–7
15 Frederick, JW, Sweeny, L, Carroll, WR, Peters, GE, Rosenthal, EL. Outcomes in head and neck reconstruction by surgical site and donor site. Laryngoscope 2013;123:1612–17
16 Hanasono, MM, Friel, MT, Klem, C, Hsu, PW, Robb, GL, Weber, RS et al. Impact of reconstructive microsurgery in patients with advanced oral cavity cancers. Head Neck 2009;31:1289–96
17 Schwam, ZG, Sosa, JA, Roman, S, Judson, BL. Complications and mortality following surgery for oral cavity cancer: analysis of 408 cases. Laryngoscope 2015;125:1869–73
18 Clark, JR, McCluskey, SA, Hall, F, Lipa, J, Neligan, P, Brown, D et al. Predictors of morbidity following free flap reconstruction for cancer of the head and neck. Head Neck 2007;29:1090–101
19 Rogers, SN, Lowe, D, Brown, JS, Vaughan, ED. The relationship between length of stay and health-related quality of life in patients treated by primary surgery for oral and oropharyngeal cancer. Int J Oral Maxillofac Surg 2001;30:209–15
20 Vega, C, Leon, X, Cervelli, D, Pons, G, Lopez, S, Fernandez, M et al. Total or subtotal glossectomy with microsurgical reconstruction: functional and oncological results. Microsurgery 2011;31:517–23
21 O'Brien, CJ, Nettle, WJ, Lee, KK. Changing trends in the management of carcinoma of the oral cavity and oropharynx. Aust N Z J Surg 1993;63:270–4
22 Gavriel, H, Thompson, E, Kleid, S, Chan, S, Sizeland, A. Safety of thromboprophylaxis after oncologic head and neck surgery. Study of 1018 patients. Head Neck 2013;35:1410–14
23 Robbins, KT, Favrot, S, Hanna, D, Cole, R. Risk of wound infection in patients with head and neck cancer. Head Neck 1990;12:143–8
24 Agra, IM, Carvalho, AL, Pontes, E, Campos, OD, Ulbrich, FS, Magrin, J et al. Postoperative complications after en bloc salvage surgery for head and neck cancer. Arch Otolaryngol Head Neck Surg 2003;129:1317–21
25 Lotfi, CJ, Cavalcanti Rde, C, Costa e Silva, AM, Latorre Mdo, R, Ribeiro Kde, C, Carvalho, AL et al. Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg 2008;138:7480
26 Velanovich, V. A meta-analysis of prophylactic antibiotics in head and neck surgery. Plast Reconstr Surg 1991;87:429–34; discussion 35
27 Simo, R, French, G. The use of prophylactic antibiotics in head and neck oncological surgery. Curr Opin Otolaryngol Head Neck Surg 2006;14:5561
28 Kasperts, N, Slotman, B, Leemans, CR, Langendijk, JA. A review on re-irradiation for recurrent and second primary head and neck cancer. Oral Oncol 2005;41:225–43
29 Awad, MI, Shuman, AG, Montero, PH, Palmer, FL, Shah, JP, Patel, SG. Accuracy of administrative and clinical registry data in reporting postoperative complications after surgery for oral cavity squamous cell carcinoma. Head Neck 2015;37:851–61
30 Amendola, BE, Wolf, AL, Coy, SR, Amendola, MA. The use of radiosurgery for salvage in recurrent tumors of the skull base. Int Pediatr 2004;19:164–9
31 Kao, SS, Ooi, EH, Peters, MD. Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: a systematic review protocol. JBI Database System Rev Implement Rep 2015;13:120–34
32 Kao, SS, Peters, MD, Krishnan, SG, Ooi, EH. Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: a systematic review. Laryngoscope 2016;126:1572–80
33 Hatcher, JL, Bell, EB, Browne, JD, Waltonen, JD. Disposition of elderly patients after head and neck reconstruction. JAMA Otolaryngol Head Neck Surg 2013;139:1236–41
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed