Mila H. Ju, MD Jennifer L. Paruch, MD

riskcalculator.facs.org

Mila H. Ju, MDJennifer L. Paruch, MD

August 15, 2013

SUSP webinar


What is the need for risk calculator?

• Informed consent– Thorough understanding of potential complications with

surgery

• Shared decision making process– Type of operation– Or if surgery should be performed at all


What is the need for risk calculator?

• Information traditionally based on– Surgeon experience– Literature

• Single institution studies• Clinical trials

• And not specific to individual patient characteristics


Development of the Risk Calculator

• ACS NSQIP Data (2009-2012)– 30-day outcomes– Risk-adjusted using patient demographics,

comorbidities and laboratory values– Collected by trained and audited surgical clinical

reviewers (SCRs)– Standardized data definitions– Captures complications that occur after discharge or at

another hospital– Superior to administrative data

Lawson et al., Annals of Surgery, December 2012


Development of the Risk Calculator

• 1,414,006 patients (393 hospitals)• All surgical subspecialties (1,557 CPT codes)• 21 pre-operative factors 10 outcomes

• Similar performance to previous,

procedure-specific risk calculators for ACS NSQIP

• Includes new Surgeon Adjustment Score (SAS)


Demonstration



Surgeon Adjustment Score

• Surgeons can adjust estimate using clinical judgment

• Risk factors not captured by the Risk Calculator

2 ONE standard deviation above CPT mean

3 TWO standard deviations above CPT mean


Surgeon Adjustment Score


Surgeon Adjustment Score: Comments from NSQIP Meeting


?


Risk calculator uses patient characteristics.

From 2012 SUSP presentation by Dr.Berenholtz and Dr.Goeschel:The Science of Safety

Help target patients with high risks.


Information from Risk Calculator will help patients get the evidence.

From 2012 SUSP presentation by Dr.Berenholtz:


Information from Risk Calculator will help reducing harm.

From 2012 SUSP presentation by Goeschel, Hobson, Wick,

& Lubomski: CUSP


• Useful tool – Informed consent / decision aid– Prevent / reduce complications

• Easily accessible– No log-in, no fee– Just internet connection


• In the future– Application for iPad, iPhone, and other smartphones– PDF, email, or print functions


Mila H. Ju, MDJennifer L. Paruch, MD



Are you going to the Annual ACS Clinical Congress?

(October 6-10, 2013)

Join the SUSP National team for breakfast!

• When: Monday, October 7 @ 6:30am EST• Where: Renaissance Hotel in DC (room 12 & 13)• Why: Network with other surgeons participating in

the SUSP project

Mila H. Ju, MD Jennifer L. Paruch, MD

Documents

Transcript of Mila H. Ju, MD Jennifer L. Paruch, MD