Design: Meta-analysis.

Setting: N/A

Patients or Participants: Online databases were searched from inception to March 2023 for gynecological studies reporting on the efficacy of the ACS-SRC.

Interventions: Following PRISMA guidelines, all full-text articles reporting ACS-SRC utilization in gynecology with predicted and actual patient complication rates were included. Studies were individually and collectively assessed for methodological quality. If 3 or more studies reported the same surgical complication outcome a meta-analysis was performed.

Measurements and Main Results: The search identified 53 studies, 5 of which were eligible for inclusion, examining ACS-SRC predictive accuracy in select complications in the following procedures: sacrocolpopexy, colpocleisis, uterosacral ligament suspension, sacrospinous ligament fixation, hysterectomy with bilateral salpingo-oophorectomy, cytoreduction surgery, and staging. Pooled data revealed the ACS-SRC to significantly underpredict serious complications (RD -0.125, 95% CI -0.171 to -0.078, p < 0.001), any complications (RD -0.247, 95% CI –0.308 to -0.187, p < 0.001), surgical site infection (SSI) (RD -0.100, 95% CI –0.121 to -0.080, p < 0.001), and urinary tract infection (UTI) (RD -0.068, 95% CI –0.112 to 0.025, p=0.002).There was no significant difference for discharge to a nursing facility, cardiac, readmission, venous thromboembolism (VTE), renal failure, return to operating room, and death. Prospective and retrospective studies assessed by their respective tools were generally deemed high quality with minimal risk of bias.

Conclusion: The ACS-SRC accurately predicts postoperative cardiac complications, death, VTE, and readmission, however, it underpredicts serious complications, any complication, UTI, and SSI after gynecologic surgery.To better predict these risks, a specialty prediction model may be needed for the gynecologic population.