What Is the Role of American College of Surgeons National Surgical Quality Improvement Program's Risk Calculator in Fracture Surgery?

IMPORTANCE: The American College of Surgeons (ACS) created the National Surgical Quality Improvement Program (NSQIP) risk calculator and database for use across surgical subspecialties and is frequently cited in surgical subspecialty peer-reviewed journals. In addition, Medicare has endorsed clinically using this risk calculator. This risk calculator has not been formally evaluated for use in distal radius fracture surgery. OBJECTIVE: This study aimed to assess the utility of the ACS-NSQIP risk calculator in hand surgery by comparing complication rates predicted by the ACS-NSQIP risk calculator against those observed from an institutional database. DESIGN: Retrospective cohort study between May 2000 and May 2020. SETTING: Academic level 1 trauma center. PARTICIPANTS: Seven hundred sixty-seven patients who underwent of open reduction and internal fixation of 790 distal radius fractures were prospectively enrolled into an institutional database. Patients aged 18 years or older who underwent volar plate fixation within 2 weeks following a distal radius fracture. MAIN OUTCOMES AND MEASURES: The primary study outcomes were the rate of "any" complications, as defined by ACS-NSQIP, and the rate of "hand-related" complications, as defined by a peer-reviewed journal publication. RESULTS: Overall, 767 patients were identified who sustained 790 distal radius fractures treated with volar plating to make up the cohort of the study. Mean age was 56.9 years, 77.0% were female, and 33.0% were type 23C1 distal radius fractures. ACS-NSQIP predicted an "any" complication rate of 1.85% (confidence interval [CI], 1.75 to 1.95). Institutional data observed "any" complication rate of 2.15% (CI, 1.01-2.91) within 30 days and 11.14% (CI, 8.99-13.42) for "long-term" any. Institutional data observed "hand-related" complication rate of 6.84% (CI, 5.18-8.83) within 30 days and 27.72% (CI, 24.56 to 30.89) for "long-term" any. CONCLUSIONS AND RELEVANCE: ACS-NSQIP fails to accurately predict the number of "hand-related" complications from distal radius fracture surgery. From a health policy, quality control, and clinical standpoint, ACS-NSQIP should be used cautiously with distal radius fracture surgery.