Refining the predictive variables in the “Surgical Risk Preoperative Assessment System” (SURPAS): a descriptive analysis
Abstract Background The Surgical Risk Preoperative Assessment System (SURPAS) is a parsimonious set of models providing accurate preoperative prediction of common adverse outcomes for individual patients. However, focus groups with surgeons and patients have developed a list of questions about and r...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-08-01
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| Series: | Patient Safety in Surgery |
| Online Access: | http://link.springer.com/article/10.1186/s13037-019-0208-2 |
| _version_ | 1818295577857753088 |
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| author | William G. Henderson Michael R. Bronsert Karl E. Hammermeister Anne Lambert-Kerzner Robert A. Meguid |
| author_facet | William G. Henderson Michael R. Bronsert Karl E. Hammermeister Anne Lambert-Kerzner Robert A. Meguid |
| author_sort | William G. Henderson |
| collection | DOAJ |
| description | Abstract Background The Surgical Risk Preoperative Assessment System (SURPAS) is a parsimonious set of models providing accurate preoperative prediction of common adverse outcomes for individual patients. However, focus groups with surgeons and patients have developed a list of questions about and recommendations for how to further improve SURPAS’s usability and usefulness. Eight issues were systematically evaluated to improve SURPAS. Methods The eight issues were divided into three groups: concerns to be addressed through further analysis of the database; addition of features to the SURPAS tool; and the collection of additional outcomes. Standard multiple logistic regression analysis was performed using the 2005–2015 American College of Surgeons National Surgical Quality Improvement Participant Use File (ACS NSQIP PUF) to refine models: substitution of the preoperative sepsis variable with a procedure-related risk variable; testing of an indicator variable for multiple concurrent procedure codes in complex operations; and addition of outcomes to increase clinical applicability. Automated risk documentation in the electronic health record and a patient handout and supporting documentation were developed. Long term functional outcomes were considered. Results Model discrimination and calibration improved when preoperative sepsis was replaced with a procedure-related risk variable. Addition of an indicator variable for multiple concurrent procedures did not significantly improve the models. Models were developed for a revised set of eleven adverse postoperative outcomes that separated bleeding/transfusion from the cardiac outcomes, UTI from the other infection outcomes, and added a predictive model for unplanned readmission. Automated documentation of risk assessment in the electronic health record, visual displays of risk for providers and patients and an “About” section describing the development of the tool were developed and implemented. Long term functional outcomes were considered to be beyond the scope of the current SURPAS tool. Conclusion Refinements to SURPAS were successful in improving the accuracy of the models, while reducing manual entry to five of the eight variables. Adding a predictor variable to indicate a complex operation with multiple current procedure codes did not improve the accuracy of the models. We developed graphical displays of risk for providers and patients, including a take-home handout and automated documentation of risk in the electronic health record. These improvements should facilitate easier implementation of SURPAS. |
| first_indexed | 2024-12-13T03:49:52Z |
| format | Article |
| id | doaj.art-c4289b75b091427dbacae73dd63bbbd2 |
| institution | Directory Open Access Journal |
| issn | 1754-9493 |
| language | English |
| last_indexed | 2024-12-13T03:49:52Z |
| publishDate | 2019-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Patient Safety in Surgery |
| spelling | doaj.art-c4289b75b091427dbacae73dd63bbbd22022-12-22T00:00:44ZengBMCPatient Safety in Surgery1754-94932019-08-0113111010.1186/s13037-019-0208-2Refining the predictive variables in the “Surgical Risk Preoperative Assessment System” (SURPAS): a descriptive analysisWilliam G. Henderson0Michael R. Bronsert1Karl E. Hammermeister2Anne Lambert-Kerzner3Robert A. Meguid4Surgical Outcomes and Applied Research program, Department of Surgery, University of Colorado School of MedicineSurgical Outcomes and Applied Research program, Department of Surgery, University of Colorado School of MedicineSurgical Outcomes and Applied Research program, Department of Surgery, University of Colorado School of MedicineSurgical Outcomes and Applied Research program, Department of Surgery, University of Colorado School of MedicineSurgical Outcomes and Applied Research program, Department of Surgery, University of Colorado School of MedicineAbstract Background The Surgical Risk Preoperative Assessment System (SURPAS) is a parsimonious set of models providing accurate preoperative prediction of common adverse outcomes for individual patients. However, focus groups with surgeons and patients have developed a list of questions about and recommendations for how to further improve SURPAS’s usability and usefulness. Eight issues were systematically evaluated to improve SURPAS. Methods The eight issues were divided into three groups: concerns to be addressed through further analysis of the database; addition of features to the SURPAS tool; and the collection of additional outcomes. Standard multiple logistic regression analysis was performed using the 2005–2015 American College of Surgeons National Surgical Quality Improvement Participant Use File (ACS NSQIP PUF) to refine models: substitution of the preoperative sepsis variable with a procedure-related risk variable; testing of an indicator variable for multiple concurrent procedure codes in complex operations; and addition of outcomes to increase clinical applicability. Automated risk documentation in the electronic health record and a patient handout and supporting documentation were developed. Long term functional outcomes were considered. Results Model discrimination and calibration improved when preoperative sepsis was replaced with a procedure-related risk variable. Addition of an indicator variable for multiple concurrent procedures did not significantly improve the models. Models were developed for a revised set of eleven adverse postoperative outcomes that separated bleeding/transfusion from the cardiac outcomes, UTI from the other infection outcomes, and added a predictive model for unplanned readmission. Automated documentation of risk assessment in the electronic health record, visual displays of risk for providers and patients and an “About” section describing the development of the tool were developed and implemented. Long term functional outcomes were considered to be beyond the scope of the current SURPAS tool. Conclusion Refinements to SURPAS were successful in improving the accuracy of the models, while reducing manual entry to five of the eight variables. Adding a predictor variable to indicate a complex operation with multiple current procedure codes did not improve the accuracy of the models. We developed graphical displays of risk for providers and patients, including a take-home handout and automated documentation of risk in the electronic health record. These improvements should facilitate easier implementation of SURPAS.http://link.springer.com/article/10.1186/s13037-019-0208-2 |
| spellingShingle | William G. Henderson Michael R. Bronsert Karl E. Hammermeister Anne Lambert-Kerzner Robert A. Meguid Refining the predictive variables in the “Surgical Risk Preoperative Assessment System” (SURPAS): a descriptive analysis Patient Safety in Surgery |
| title | Refining the predictive variables in the “Surgical Risk Preoperative Assessment System” (SURPAS): a descriptive analysis |
| title_full | Refining the predictive variables in the “Surgical Risk Preoperative Assessment System” (SURPAS): a descriptive analysis |
| title_fullStr | Refining the predictive variables in the “Surgical Risk Preoperative Assessment System” (SURPAS): a descriptive analysis |
| title_full_unstemmed | Refining the predictive variables in the “Surgical Risk Preoperative Assessment System” (SURPAS): a descriptive analysis |
| title_short | Refining the predictive variables in the “Surgical Risk Preoperative Assessment System” (SURPAS): a descriptive analysis |
| title_sort | refining the predictive variables in the surgical risk preoperative assessment system surpas a descriptive analysis |
| url | http://link.springer.com/article/10.1186/s13037-019-0208-2 |
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