JAAOS - 2026-03-31 - Journal Article
What Is the Role of American College of Surgeons National Surgical Quality Improvement Program's Risk Calculator in Fracture Surgery?
Martinez FA, Shin AY, Wright BH, Hannon CP, Pulos N
Topics
Key Takeaway
ACS-NSQIP predicted a 1.85% 'any' complication rate for distal radius ORIF, but observed long-term hand-related complications reached 27.72%—a 15-fold underestimation.
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Summary
This study compared ACS-NSQIP predicted complication rates against observed rates from a prospectively enrolled institutional database of 790 volar plate fixations for distal radius fractures. ACS-NSQIP predicted a 1.85% 'any' complication rate; the observed 30-day 'any' complication rate was 2.15%, but long-term 'any' complications reached 11.14% and long-term hand-related complications reached 27.72%. ACS-NSQIP systematically fails to capture hand-specific morbidity including hardware irritation, tendon rupture, and carpal tunnel syndrome that define the true complication burden of this procedure.
Key Limitation
The comparison conflates NSQIP's strictly defined 30-day window with an undefined long-term institutional follow-up period, making the magnitude of underestimation appear larger than a true apples-to-apples comparison would support.
Original Abstract
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.