Utilizing the Most Accurate Preoperative Risk Calculator

Mir, Wasey Ali Yadullahi; Fiumara, Francesco; Shrestha, Dhan Bahadur; Gaire, Suman; Verda, Larissa

doi:10.7759/cureus.17054

Cited by 3 publications

(2 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…42 Online real-time estimation of surgical risk is made possible by the American College of Surgeons National Surgery Quality Improvement Program (ACS-NSQIP) risk calculator tool, which uses 21 preoperative covariates to predict mortality, overall complication rate, and the specific risk of surgical site infection or urinal tract infection. 44 The ACS-NSQIP has a high accuracy to predict postoperative mortality, but it is less accurate for morbidity. 40 Modifiable preoperative risk factors, such as anemia, malnutrition, decompensated diabetes mellitus, pulmonary function, and smoking, should be corrected within a prehabilitation program.…”

Section: Preoperative Risk Stratification and Risk Minimizationmentioning

confidence: 99%

Classification of Adverse Events in Adult Surgery

2023

View full text Add to dashboard Cite

Successful surgery combines quality (achievement of a positive outcome) with safety (avoidance of a negative outcome). Outcome assessment serves the purpose of quality improvement in health care by establishing performance indicators and allowing the identification of performance gaps. Novel surgical quality metric tools (benchmark cutoffs and textbook outcomes) provide procedure-specific ideal surgical outcomes in a subgroup of well-defined low-risk patients, with the aim of setting realistic and best achievable goals for surgeons and centers, as well as supporting unbiased comparison of surgical quality between centers and periods of time. Validated classification systems have been deployed to grade adverse events during the surgical journey: (1) the ClassIntra classification for the intraoperative period; (2) the Clavien–Dindo classification for the gravity of single adverse events; and the (3) Comprehensive Complication Index (CCI) for the sum of adverse events over a defined postoperative period. The failure to rescue rate refers to the death of a patient following one or more potentially treatable postoperative adverse event(s) and is a reliable proxy of the institutional safety culture and infrastructure. Complication assessment is undergoing digital transformation to decrease resource-intensity and provide surgeons with real-time pre- or intraoperative decision support. Standardized reporting of complications informs patients on their chances to realize favorable postoperative outcomes and assists surgical centers in the prioritization of quality improvement initiatives, multidisciplinary teamwork, surgical education, and ultimately, in the enhancement of clinical standards.

show abstract

Section: Preoperative Risk Stratification and Risk Minimizationmentioning

confidence: 99%

Classification of Adverse Events in Adult Surgery

2023

View full text Add to dashboard Cite

show abstract

“…However, these calculators are not specific for spine surgery patients per se , and should not be used for organ-centered risk assessment. 14,15 The Risk Assessment Tool, derived and validated with a single-center cohort of spine surgery patients, provides a comprehensive risk assessment for adverse events after spine surgery with an area under the receiver operating curve of 0.7. 16 Independent risk factors identified in the Risk Assessment Tool include cardiovascular disease, diabetes, smoking history, systemic malignancy, obesity, substance abuse, and psychiatric disorders.…”

Section: Preoperative Optimization and Risk Stratificationmentioning

confidence: 99%

Perioperative Management for Complex Spine Fusion Surgery

Carabini,

Koski,

Bebawy

2023

Anesthesiology

View full text Add to dashboard Cite

show abstract

Number of comorbidities and their impact on perioperative outcome and costs – a single centre cohort study

et al. 2022

View full text Add to dashboard Cite

AIMS OF THE STUDY: Multimorbidity is a growing global health problem, resulting in an increased perioperative risk for surgical patients. Data on both the prevalence of multimorbidity and its impact on perioperative outcome are limited. The American Society of Anesthesiologists (ASA) classification uses only the single most severe systemic disease to define the ASA class and ignores multimorbidity. This study aimed to assess the number and type of all anaesthesia-relevant comorbidities and to analyse their impact on outcome and hospital costs. METHODS: This cohort study is nested in the ClassIntra® validation study and includes only patients enrolled at the University Hospital of Basel. Approximately 30 patients per surgical discipline undergoing any type of in-hospital surgery were followed up until hospital discharge to record all intra- and postoperative adverse events. In addition, the type and severity of all perioperatively relevant comorbidities were extracted from the electronic medical record according to a predefined list. The primary endpoint was the number of all anaesthesia-relevant comorbidities by ASA class. Using structural equation models, the direct and indirect effects of comorbidities on costs were estimated after adjustment for the ASA class and further relevant confounders and mediators. RESULTS: Of 320 enrolled patients, 27 were ASA I (8%), 150 ASA II (47%), 116 ASA III (36%) and 27 ASA IV (8%). The median number of comorbidities per patient was 5 (range 0–18), this number significantly increasing with higher ASA class: 1 comorbidity (95% CI 0.0–2.0) in ASA I, 4 comorbidities (3.8–4.2) in ASA II, 9 (8.1–9.9) in ASA III and 12 (10–14) in ASA IV patients. Independent of ASA class, each additional comorbidity increased hospital costs by EUR 1,198 (95% CI 288–2108) with almost identical proportions of direct and indirect effects. The number of anaesthesia-relevant comorbidities also increased postoperative complications and postoperative length of hospital stay. CONCLUSIONS: Multimorbidity in perioperative patients is highly prevalent and has a relevant impact on hospital costs, independent of the ASA class. Incorporating multimorbidity into the ASA classification might be warranted to improve its predictive ability and support adequate reimbursement. The ClassIntra® validation study had been registered on ClinicalTrials.gov (NCT03009929).

show abstract

Utilizing the Most Accurate Preoperative Risk Calculator

Cited by 3 publications

References 22 publications

Classification of Adverse Events in Adult Surgery

Classification of Adverse Events in Adult Surgery

Perioperative Management for Complex Spine Fusion Surgery

Number of comorbidities and their impact on perioperative outcome and costs – a single centre cohort study

Contact Info

Product

Resources

About