Power of Judgment: The Significance of Kant's Philosophy for the Medical System Today

Weigel, Thomas Friedrich; Hanisch, E.; Hanisch, A; Buia, Alexander; Lp, Müller; Messias, José; Hessler, C

doi:10.1016/j.jsurg.2018.07.007

Cited by 1 publication

(1 citation statement)

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“…At least for the time being, the risk calculator cannot replace the time-honored experienced surgeon guiding the less experienced surgeon in skill development, work experience and secure decision making [25]. Still, it is important to pursue strategies for further complication reduction concentrating more on the individual patient risk to ensure the highest possible safety and quality for patients.…”

Section: Discussionmentioning

confidence: 99%

Report of a Quality Improvement Program for Reducing Postoperative Complications by Using a Surgical Risk Calculator in a Cohort of General Surgery Patients

et al. 2020

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Purpose The study investigates whether postoperative complications in elective surgery can be reduced by using a risk calculator via raising the awareness of the surgeon in a preoperative briefing. Postoperative complications like wound infections or pneumonia result in a high burden for healthcare systems. Multiple quality improvement programs address this problem like the ACS NSQIP Surgical Risk Calculator® (SRC). Methods To determine whether the preoperative usage of the SRC could reduce inpatient postoperative complications, two groups of 832 patients each were compared using propensity score matching. The SRC was employed retrospectively in the period 2012/2013 in one group (“Retro”) and prospectively in the other group (“Prosp”) in the period 2014/2015. Actual inpatient postoperative complications were classified by SRC complication categories and compared with the Clavien–Dindo complication classification system (Dindo et al. in Ann Surg 240:205–213, 2004). Results Comparing SRC “serious complication” and SRC “any complication,” a nonsignificant increase in the “Prosp”‐group was apparent (serious complication: 6.6% vs. 8.5%, p = 0.164; any complication: 8.5% vs. 9.7%, p = 0.444). Conclusion Use of the SRC neither reduces inpatient postoperative complications nor the severity of complications. The calculations of the SRC rely on a 30‐day postoperative follow‐up. Poor sensitivity and medium specificity of the SRC showed that the SRC could not make accurate predictions in a short follow‐up time averaging 6 days. Alternatively, since the observed complication rate was low in our study, in an environment of already highly implemented risk management tools, reductions in complications are not easily achieved.

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Section: Discussionmentioning

confidence: 99%