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Online Tool Offers Personalized Estimates of Surgical Risks

August 20, 2013
by Rajiv Leventhal
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A new tool developed by the American College of Surgeons has been designed to quickly and easily estimate patient-specific postoperative complication risks for almost all operations, according to research findings in the Journal of the American College of Surgeons.

For the study, which will appear in the journal later this year, lead author Karl Bilimoria, M.D., director of the Surgical Outcomes and Quality Improvement Center at Northwestern University in Chicago, and colleagues used highly detailed and accurate ACS National Surgical Quality Improvement Program (NSQUIP) data collected from nearly 400 hospitals and 1.4 million patients to develop a universal surgical risk calculator that covers more than 1,500 unique surgical procedures across multiple specialties. The authors leveraged the highly accurate outcomes data collected by ACS NSQIP to create the Surgical Risk Calculator, which allows surgeons to quickly enter a total of 22 preoperative patient risk factors about their patients.

Next, the risk calculator estimates the potential risks of mortality and eight important postoperative complications and displays these risks in comparison to “an average patient’s risks.” The authors also performed tests to ensure the validity of the risk estimates provided by the Surgical Risk Calculator.

The investigators reported that the ACS NSQIP Surgical Risk Calculator yielded excellent prediction results for death, overall complication, and serious complication rates, as well as six additional postoperative complications: pneumonia, heart problem, surgical site infection, urinary tract infection, blood clot, and kidney failure. In addition, the Surgical Risk Calculator estimates a customized length of hospital stay for the patient.

As there are hard-to-measure factors that may increase a patient’s risk of postoperative complications, the web-based risk calculator includes a Surgeon Adjustment Score that allows a surgeon to increase the risk of an operation based on his or her subjective assessment of a patient. This feature enables surgeons to better counsel patients using both the modeled estimate along with the surgeon’s experience and evaluation of the patient.

“Predicting postoperative risks, and identifying patients at a higher risk of complications, has traditionally been based on anecdotal experience of the individual surgeon or small studies from other institutions,” Dr. Bilimoria said in a statement. “Importantly, these risk estimates have been generic and not specific to an individual patient’s risk factors. To have truly informed consent and shared decision making with a patient, we need the ability to provide customized, personal risk estimates for patients undergoing any operation.”

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