riskcalculator.facs.org mila h. ju, md jennifer l. paruch, md august 15, 2013 susp webinar
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riskcalculator.facs.org
What is the need for risk calculator?
• Informed consent– Thorough understanding of potential complications with
surgery
• Shared decision making process– Type of operation– Or if surgery should be performed at all
riskcalculator.facs.org
What is the need for risk calculator?
• Information traditionally based on– Surgeon experience– Literature
• Single institution studies• Clinical trials
• And not specific to individual patient characteristics
riskcalculator.facs.org
Development of the Risk Calculator
• ACS NSQIP Data (2009-2012)– 30-day outcomes– Risk-adjusted using patient demographics,
comorbidities and laboratory values– Collected by trained and audited surgical clinical
reviewers (SCRs)– Standardized data definitions– Captures complications that occur after discharge or at
another hospital– Superior to administrative data
Lawson et al., Annals of Surgery, December 2012
riskcalculator.facs.org
Development of the Risk Calculator
• 1,414,006 patients (393 hospitals)• All surgical subspecialties (1,557 CPT codes)• 21 pre-operative factors 10 outcomes
• Similar performance to previous,
procedure-specific risk calculators for ACS NSQIP
• Includes new Surgeon Adjustment Score (SAS)
riskcalculator.facs.org
Surgeon Adjustment Score
• Surgeons can adjust estimate using clinical judgment
• Risk factors not captured by the Risk Calculator
2 ONE standard deviation above CPT mean
3 TWO standard deviations above CPT mean
riskcalculator.facs.org
Risk calculator uses patient characteristics.
From 2012 SUSP presentation by Dr.Berenholtz and Dr.Goeschel:The Science of Safety
Help target patients with high risks.
riskcalculator.facs.org
Information from Risk Calculator will help patients get the evidence.
From 2012 SUSP presentation by Dr.Berenholtz:
riskcalculator.facs.org
Information from Risk Calculator will help reducing harm.
From 2012 SUSP presentation by Goeschel, Hobson, Wick,
& Lubomski: CUSP
riskcalculator.facs.org
• Useful tool – Informed consent / decision aid– Prevent / reduce complications
• Easily accessible– No log-in, no fee– Just internet connection
riskcalculator.facs.org
• In the future– Application for iPad, iPhone, and other smartphones– PDF, email, or print functions
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