Use of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator During Preoperative Risk Discussion: The Patient Perspective

Raymond, Britany L.; Wanderer, Jonathan P.; Hawkins, Alexander T.; Geiger, Timothy M.; Ehrenfeld, Jesse M.; Stokes, John W.; McEvoy, Matthew D.

doi:10.1213/ane.0000000000003718

Cited by 39 publications

(44 citation statements)

References 27 publications

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“…In general, patients request structural and individualised information from HCPs prior to surgery, and not solely regarding physical exercise [12]. It has been shown that patients at high risk tend to underestimate their risk of postoperative morbidity, but when made aware, the majority would consider taking action to preoperative optimisation [31]. Clinician-patient communication has shown to have positive effects on outcomes such as patient knowledge and understanding, adherence and better self-care abilities [32].…”

Section: Discussionmentioning

confidence: 99%

Older patients’ attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery—a gap between awareness and action

Karlsson

Dahl

Rydwik

et al. 2019

Support Care Cancer

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Purpose Time for preoperative optimisation prior to colorectal cancer surgery is limited and older people tend to decline exercise interventions. This study sought to describe attitudes towards, and perceptions of, preoperative physical activity and exercise in older people prior to colorectal cancer surgery. Methods This is a qualitative interview study, analysed with inductive content analysis. Seventeen participants scheduled for colorectal surgery were recruited as a purposeful sample from two hospitals in Stockholm, Sweden. Individual semistructured interviews were conducted, face-to-face (n = 8) or by telephone (n = 9). Results Nine participants were male, median age was 75 years (range 70-91). The theme, 'a gap between awareness and action', was identified based on two main categories: 'Attitudes towards preoperative physical exercise have a multifactorial base' and 'Preoperative physical exercise is possible with a push in the right direction'. The material described a gap between awareness of the benefits of physical activity and reports of performing physical activity. The reasons for the gap between thoughts and action in this respect seem to be multifactorial. Support from others emerged as an important possibility for overcoming the gap. Conclusions A gap between the patients' awareness and action appeared in our material. Understanding this can guide healthcare professionals (HCPs) as to the support needed preoperatively. Advice on physical exercise before surgery should be specific, and individually tailored support for action should be offered. This support should also consider the individual's current physical activity and preoperative attitude towards physical exercise.

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Section: Discussionmentioning

confidence: 99%

Older patients’ attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery—a gap between awareness and action

Karlsson

Dahl

Rydwik

et al. 2019

Support Care Cancer

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“…Online risk calculators, mobile device applications, and automated predictive analytic platforms can be easily accessed to accomplish these goals. [1][2][3][4] However, these models often ignore intraoperative data and thereby miss potentially important opportunities to generate updated predictions that can further inform future decisions regarding postoperative triage, surveillance for complications, targeted preventative measures (e.g., renal protection bundles for patients at high risk for acute kidney injury [AKI], and continuous cardiorespiratory monitoring for patients at high risk for cardiovascular complications).…”

Section: Introductionmentioning

confidence: 99%

Added Value of Intraoperative Data for Predicting Postoperative Complications: The MySurgeryRisk PostOp Extension

Datta

Loftus

Ruppert

et al. 2020

Journal of Surgical Research

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Background: Models that predict postoperative complications often ignore important intraoperative events and physiological changes. This study tested the hypothesis that accuracy, discrimination, and precision in predicting postoperative complications would improve when using both preoperative and intraoperative data input data compared with preoperative data alone. Methods: This retrospective cohort analysis included 43,943 adults undergoing 52,529 inpatient surgeries at a single institution during a 5-y period. Random forest machine learning models in the validated MySurgeryRisk platform made patient-level predictions for seven postoperative complications and mortality occurring during hospital admission using electronic health record data and patient neighborhood characteristics. For each outcome, one model trained with preoperative data alone; one model trained with both preoperative and intraoperative data. Models were compared by accuracy, discrimination (expressed as area under the receiver operating characteristic curve), precision (expressed as area under the precision-recall curve), and reclassification indices. Results: Machine learning models incorporating both preoperative and intraoperative data had greater accuracy, discrimination, and precision than models using preoperative data alone for predicting all seven postoperative complications (intensive care unit length of stay >48 h, mechanical ventilation >48 h, neurologic complications including delirium, cardiovascular complications, acute kidney injury, venous thromboembolism, and wound complications), and in-hospital mortality (accuracy: 88% versus 77%; area under the receiver operating characteristic curve: 0.93 versus 0.87; area under the precision-recall

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“…However, the use of visual decisionmaking aids is associated with greater patient knowledge and satisfaction with their decision to have surgery [15]. NSQIP is a free and easy to use tool which has the potential to address this need for a wide range of operations [16]. There is currently a paucity of data regarding its validity in gynae-oncology, highlighting the importance of analysing NSQIP further in this field.…”

Section: Discussionmentioning

confidence: 99%

The Utility of a Personalised Risk Calculator in Gynae-Oncology Surgery

Murray¹,

Lim²,

Howells³

et al. 2020

COR

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Objective: The objective of this study was to assess the ability of the American College of Surgeons (ACS) NSQIP surgical risk calculator to accurately identify patients at increased risk of perioperative complication following surgery for gynaecological malignancy. Methods: A retrospective review of 142 patients who underwent major surgery under the gynae-oncology team between 06/08/2018-16/04/2019 at the University Hospital of Wales. Pre-operative factors combined with a procedure-specific code generated the predicted risk of 13 post-operative complications for each patient. Brier scores assessed calibration and receiver operated curves (AUC) evaluated the discriminative power of NSQIP. Results: Complications were experienced by 50/142 (35.2%) patients. The calculator displayed adequate calibration when used to predict serious complications (Brier = 0.070), readmission (Brier = 0.058), return to OR (Brier = 0.000) and UTI (Brier = 0.001). It had the greatest discriminative power when predicting the risk of serious complications (AUC = 0.672; 95% CI, 0.481-0.863). The calculator successfully identified a majority of patients who had a complication as being of ‘above average risk’ for all complications, apart from return to OR, based on their pre-operative factors. Discussion: NSQIP has previously been demonstrated to be a useful pre-operative tool for evaluating the risk of post-operative complications in colorectal surgery. This study suggests that in the setting of gynaeoncology surgery the calculator does not have adequate discriminative power to be an absolute predictor of all complications, however, it may be useful in identifying patients who are likely to develop serious complications and those at above average risk of complications.

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Use of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator During Preoperative Risk Discussion: The Patient Perspective

Abstract: The ACS Calculator may be of particular benefit to high-risk surgical populations by providing realistic expectations of outcomes and recovery. Use of this tool may also provide motivation for patients to participate in risk reduction strategies.

Cited by 39 publications

References 27 publications

Older patients’ attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery—a gap between awareness and action

Older patients’ attitudes towards, and perceptions of, preoperative physical activity and exercise prior to colorectal cancer surgery—a gap between awareness and action

Added Value of Intraoperative Data for Predicting Postoperative Complications: The MySurgeryRisk PostOp Extension

The Utility of a Personalised Risk Calculator in Gynae-Oncology Surgery

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