Risk of discharge to postacute care: a patient-centered outcome for the american college of surgeons national surgical quality improvement program surgical risk calculator.

Abstract:

IMPORTANCE:Individualized risk prediction tools have an important role as decision aids for use by patients and surgeons before surgery. Patient-centered outcomes should be incorporated into such tools to widen their appeal and improve their usability. OBJECTIVE:To develop a patient-centered outcome for the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator, a web-based, individualized risk prediction tool. DESIGN, SETTING, AND PARTICIPANTS:Retrospective cohort study using data from the ACS NSQIP, a national clinical data registry. A total of 973 211 patients from July 2010 to June 2012, encompassing 392 hospitals, were used in this analysis. MAIN OUTCOMES AND MEASURES:Risk of discharge to a postacute care setting. RESULTS:The overall rate of discharge to postacute care was 8.8%. Significant predictors of discharge to postacute care included being 85 years or older (odds ratio [OR] = 9.17; 95% CI, 8.84-9.50), the presence of septic shock (OR = 2.43; 95% CI, 2.20-2.69) or ventilator dependence (OR = 2.81; 95% CI, 2.56-3.09) preoperatively, American Society of Anesthesiologists class of 4 or 5 (OR = 3.59; 95% CI, 3.46-3.71), and totally dependent functional status (OR = 2.27; 95% CI, 2.11-2.44). The final model predicted risk of discharge to postacute care with excellent accuracy (C statistic = 0.924) and calibration (Brier score = 0.05). CONCLUSIONS AND RELEVANCE:Individualized risk of discharge to postacute care can be predicted with excellent accuracy. This outcome will be incorporated into the ACS NSQIP Surgical Risk Calculator.

journal_name

JAMA Surg

journal_title

JAMA surgery

authors

Mohanty S,Liu Y,Paruch JL,Kmiecik TE,Cohen ME,Ko CY,Bilimoria KY

doi

10.1001/jamasurg.2014.3176

subject

Has Abstract

pub_date

2015-05-01 00:00:00

pages

480-4

issue

5

eissn

2168-6254

issn

2168-6262

pii

2207938

journal_volume

150

pub_type

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