Surgery risk calculator
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Surgical Risk Calculators: Enhancing Decision-Making in Surgery
Introduction to Surgical Risk Calculators
Surgical risk calculators are tools designed to estimate the likelihood of adverse outcomes following surgery. These tools utilize patient-specific data to provide empirically derived risk assessments, aiding both surgeons and patients in making informed decisions. The development and validation of these calculators have been a significant focus in recent years, with various models being proposed and tested for accuracy and usability.
Machine-Learning-Based Predictive Tools
POTTER Calculator for Emergency Surgery
The Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) calculator is a novel tool that leverages machine-learning techniques to predict postoperative outcomes in emergency surgery. Unlike traditional linear models, POTTER uses Optimal Classification Trees (OCT) to account for nonlinear interactions among variables, making it highly adaptive and accurate. In a study involving 382,960 emergency surgery patients, POTTER demonstrated superior performance in predicting mortality and morbidity compared to other established calculators, such as the American Society of Anesthesiologists (ASA) and the Emergency Surgery Score (ESS).
Impact on Clinical Decision-Making
Influence on Surgeons' Risk Perception
A randomized trial investigated how exposure to risk calculator data influences surgeons' assessments of operative risks and their subsequent decisions to operate. Surgeons who used the risk calculator provided risk estimates that closely matched the calculator's values and showed less variability in their assessments. However, the use of the calculator did not significantly alter their likelihood of recommending surgery. This suggests that while risk calculators can enhance the accuracy of risk perception, they may not necessarily change clinical decision-making behaviors.
Universal Surgical Risk Calculators
ACS NSQIP Surgical Risk Calculator
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) developed a universal surgical risk calculator that uses 21 preoperative factors to predict various postoperative outcomes. This tool has shown excellent performance in predicting mortality and morbidity across a wide range of surgical procedures. It also allows for surgeon input to adjust risk estimates, enhancing its utility as a decision-support tool. However, its performance can vary depending on the specific surgical context and patient population .
Patient Perspectives and Outcomes
Patient Understanding and Anxiety
The ACS NSQIP surgical risk calculator has been evaluated from the patient perspective, particularly in preoperative discussions. Most patients found the tool easy to interpret and expressed a desire to review their risk reports before surgery. High-risk patients often underestimated their risks, but reviewing the calculated risks motivated many to consider prehabilitation to reduce perioperative risks. Interestingly, knowledge of personal risk calculations generally did not increase patient anxiety.
Specialized Applications
Spine Surgery and Total Joint Arthroplasty
The ACS NSQIP surgical risk calculator has been tested in specific surgical contexts, such as elective spine surgery and total joint arthroplasty. In spine surgery, the calculator showed poor predictive performance for most outcomes, likely due to the low incidence of complications in the studied population. In total joint arthroplasty, the calculator demonstrated fair utility in predicting discharge to post-acute care facilities but had limited usefulness for other outcomes like 90-day readmission and return to the operating room.
Development of Localized Tools
CARES Surgical Risk Calculator
The Combined Assessment of Risk Encountered in Surgery (CARES) calculator was developed to address the limitations of existing tools in local practice. This calculator, derived from a large dataset of patients in Singapore, predicts 30-day postoperative mortality and the need for ICU admission using nine preoperative variables. The CARES calculator has shown high accuracy and outperformed the ASA-Physical Status classification in predictive performance.
Conclusion
Surgical risk calculators are valuable tools that enhance the accuracy of risk assessments and support informed decision-making in surgery. While tools like POTTER and the ACS NSQIP calculator have demonstrated high accuracy, their performance can vary based on the surgical context and patient population. Localized tools like the CARES calculator offer tailored solutions that may provide more accurate predictions in specific settings. Overall, these calculators play a crucial role in improving surgical outcomes and patient care.
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