The value of the “Surgical Risk Preoperative Assessment System” (SURPAS) in preoperative consultation for elective surgery: a pilot study

Abstract

Background Risk assessment is essential to informed decision making in surgery. Preoperative use of the Surgical Risk Preoperative Assessment System (SURPAS) providing individualized risk assessment, may enhance informed consent. We assessed patient and provider perceptions of SURPAS as a risk assessment tool. Methods A convergent mixed-methods study assessed SURPAS’s trial implementation, concurrently collecting quantitative and qualitative data, separately analyzing it, and integrating the results. Patients and providers were surveyed and interviewed on their opinion of how SURPAS impacted the preoperative encounter. Relationships between patient risk and patient and provider assessment of SURPAS were examined. Results A total of 197 patients were provided their SURPAS postoperative risk estimates in nine surgeon’s clinics. Of the total patients, 98.8% reported they understood their surgical risks very or quite well after exposure to SURPAS; 92.7% reported SURPAS was very helpful or helpful. Providers shared that 83.4% of the time they reported SURPAS was very or somewhat helpful; 44.7% of the time the providers reported it changed their interaction with the patient and this change was beneficial 94.3% of the time. As patient risk increased, providers reported that SURPAS was increasingly helpful ( p < 0.0001). Conclusions Patients and providers reported the use of SURPAS helpful and informative during the preoperative risk assessment of patients, thus improving the surgical decision making process. Patients thought that SURPAS was helpful regardless of their risk level, whereas providers thought that SURPAS was more helpful in higher risk patients.

Surgeons’ Attitudes About Use of Preoperative Risk Assessment Tools

“…Further, multiple validation studies have been done using internal [16][17][18][19][20] and external [21][22][23][24] validation methods, to address the issue of "trust" in the accuracy of the models. Several pilot studies have also been completed recently showing that after SURPAS patients understand their risks for surgery very well [2] and have improved satisfaction, comfort, and anxiety about their operations [9].…”

“…Despite advances in surgical technique, understanding of surgical pathology and pathophysiology, and knowledge of factors that increase risk of adverse post-operative outcomes, accurate assessment of a patient's surgical risk preoperatively remains challenging. Although surgical risk assessment tools such as the American College of Surgeons' Surgical Risk Calculator, [1] the Veterans Affairs Surgical Quality Improvement Program (VASQIP) Patient Risk Calculation, and the Surgical Risk Preoperative Assessment System (SURPAS) [2] accurately predict risk of adverse postoperative patient outcomes, these tools have not been widely adopted by surgeons to routinely assess preoperative surgical risk [3,4]. Surgeons are accurate at predicting preoperative risk in low-risk patients, but they are inaccurate when predicting risk of adverse events in high-risk patients.…”

“…Surgeons are accurate at predicting preoperative risk in low-risk patients, but they are inaccurate when predicting risk of adverse events in high-risk patients. [2] This is problematic as high-risk patients are the most likely to bene t from pre-operative counseling, informed consent discussions, and potential risk mitigation efforts.…”

Attitudes about use of preoperative risk assessment tools: a survey of surgeons and surgical residents in an academic health system

“…Accurate preoperative assessment of a patient’s surgical risk for postoperative complications is a challenging but important task for surgeons. Although surgical risk assessment tools such as the American College of Surgeons’ Surgical Risk Calculator, [ 1 ] the Veterans Affairs Surgical Quality Improvement Program (VASQIP) Patient Risk Calculator, and the Surgical Risk Preoperative Assessment System (SURPAS) [ 2 ] accurately predict risk of adverse postoperative patient outcomes, these tools have not been widely adopted by surgeons to routinely assess preoperative surgical risk [ 3 , 4 ]. Surgeons are accurate at predicting preoperative risk in low-risk patients, but they are inaccurate when predicting risk of adverse events in high-risk patients.…”

“…Surgeons are accurate at predicting preoperative risk in low-risk patients, but they are inaccurate when predicting risk of adverse events in high-risk patients. [ 2 , 5 ] This is problematic as high-risk patients are the most likely to benefit from pre-operative counseling, informed consent discussions, and potential risk mitigation efforts.…”