A new tool developed by the American College of Surgeons enables physicians and the public to more accurately assess the risk involved with 1,500 surgical procedures. A study describing how the Surgical Risk Calculator was developed is available online at the Journal of the American College of Surgeons.
"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," lead author Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University in Chicago, said. "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."
Detailed outcomes data from nearly 400 hospitals and 1.4 million patients was collected through the ACS National Surgical Quality Improvement Program. The creators rigorously tested the calculator and focused on using everyday language that would make it easy for the public to understand, according to an announcement.
The physician can enter 22 preoperative patient risk factors about their patients. The tool calculates risk of mortality, as well as eight important postoperative complications. It displays the risks in comparison to "an average patient's risks."
The researcher reported that the 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. The tool also provides an estimated length of hospital stay for the patient.
Because there often are hard-to-measure factors that can affect risk, the calculator also allows surgeons to adjust their scores based on subjective assessments of a patient's condition in order to better counsel the patient.
The Physician Quality Reporting System may soon provide financial incentives for surgeons to calculate patient-specific surgical risks and discuss them with patients, the announcement says.
The Florida Hospital Association recently reported that through a statewide quality initiative, surgical complications fell 14.5 percent over 15 months among 67 participating hospitals.
Surgical death rates declined about 50 percent over 10 years in New York hospitals, according to a report card from the Niagara Health Quality Coalition. It attributed the improvements largely to required reporting of outcomes and ongoing care improvements.