Predictive value of the American college of surgeons "surgical risk calculator" (ACS-NSQIP SRC) for plastic and reconstructive surgery: a validation study from an academic tertiary referral center in Germany.

[AIMS] The American College of Surgeons Surgical Risk Calculator (ACS-NSQIP SRC) was designed to predict morbidity and mortality in order to help providing informed consent. This study evaluated its performance in the field of plastic and reconstructive surgery for patients undergoing body contouring and breast reconstruction procedures.

[METHODS] A retrospective analysis of patients undergoing body contouring and breast reconstruction procedures from January 1, 2022 to November 1, 2024 was performed.

[RESULTS] The ACS-NSQIP SRC showed good prediction only for severe complications in patients undergoing breast reconstruction with DIEP flap (AUC = 0.727); overall prediction and calibration for the remaining 15 subgroups was poor. The incidence of overall and general complications, as well as length of hospital stay was underestimated.

[CONCLUSIONS] The overall performance of the ACS-NSQIP SRC was poor, a finding that underlines the importance of individual decision-making, also considering the surgeon's expertise and patient-specific characteristics.