Development and Validation of a Multivariable Prediction Model for Postoperative Intensive Care Unit Stay in a Broad Surgical Population.

Importance: Despite limited capacity and expensive cost, there are minimal objective data to guide postoperative allocation of intensive care unit (ICU) beds. The Surgical Risk Preoperative Assessment System (SURPAS) uses 8 preoperative variables to predict many common postoperative complications, but it has not yet been evaluated in predicting postoperative ICU admission.

Objective: To determine if the SURPAS model could accurately predict postoperative ICU admission in a broad surgical population.

Using the Surgical Risk Preoperative Assessment System to Define the "High Risk" Surgical Patient.

Background: Defining a "high risk" surgical population remains challenging. Using the Surgical Risk Preoperative Assessment System (SURPAS), we sought to define "high risk" groups for adverse postoperative outcomes.

Materials And Methods: We retrospectively analyzed the 2009-2018 American College of Surgeons National Surgical Quality Improvement Program database.

Accuracy of the surgical risk preoperative assessment system universal risk calculator in predicting risk for patients undergoing selected operations in 9 specialty areas.

Background: The universal Surgical Risk Preoperative Assessment System (SURPAS) prediction models for postoperative adverse outcomes have good accuracy for estimating risk in broad surgical populations and for surgical specialties. The accuracy in individual operations has not yet been assessed. The objective of this study was to evaluate the Surgical Risk Preoperative Assessment System in predicting adverse outcomes for selected individual operations.

A Pilot Study of Patient-Reported Outcome Measures Across a Broad Sample of Surgical Patients.

Background: Patient-reported outcomes (PROs) have the potential to aid in surgical decision-making, predict surgical outcomes, assess recovery, and evaluate long-term success. We performed a pilot study testing the ability to use PROs in a broad surgical population in preparation for wide spread use.

Material And Methods: Surgical patients completed five Patient-Reported Outcome Measurement Information System (PROMIS) measures during their preoperative encounter in the preanesthesia clinic and again postoperatively via emailed link.

Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database.

Background: Postoperative complications, length of index hospital stay, and unplanned hospital readmissions are important metrics reflecting surgical care quality. Postoperative infections represent a substantial proportion of all postoperative complications. We examined the relationships between identification of postoperative infection prehospital and posthospital discharge, length of stay, and unplanned readmissions in the American College of Surgeons National Surgical Quality Improvement Program database across nine surgical specialties.

A comparison of the new, parsimonious tool Surgical Risk Preoperative Assessment System (SURPAS) to the American College of Surgeons (ACS) risk calculator in emergency surgery.

Background: The Surgical Risk Preoperative Assessment System accurately predicts postoperative complications in elective surgery using only 8 preoperative variables, but its performance in emergency surgery has not been evaluated. We hypothesized that the Surgical Risk Preoperative Assessment System accurately predicts postoperative complications in emergency surgery and compared its performance to that of the American College of Surgeons Surgical Risk Calculator.

Methods: We calculated the Surgical Risk Preoperative Assessment System and the American College of Surgeons Surgical Risk Calculator risk estimates in a random sample of 1,010 emergency surgery cases from the American College of Surgeons National Surgical Quality Improvement Program 2014 to 2017 database.

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

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.

Use of Surgical Risk Preoperative Assessment System (SURPAS) and Patient Satisfaction During Informed Consent for Surgery.

Background: The objective of this study was to determine the effects of using the Surgical Risk Preoperative Assessment System (SURPAS) on patient satisfaction and surgeon efficiency in the surgical informed consent process, as compared to surgeons' "usual" consent process.

Study Design: Patient perception of the consent process was assessed via survey in 2 cohorts: 10 surgeons in different specialties used their "usual" consent process for 10 patients; these surgeons were then taught to use SURPAS, and they used it during the informed consent process of 10 additional patients. The data were compared using Fisher's exact test and the Cochran-Mantel-Haenszel test.

Systematic Review of Preoperative Risk Discussion in Practice.

Background: Informed consent is an ethical imperative of surgical practice. This requires effective communication of procedural risks to patients and is learned during residency. No systematic review has yet examined current risk disclosure.

Accurate Preoperative Prediction of Discharge Destination Using 8 Predictor Variables: A NSQIP Analysis.

Background: With inpatient length of stay decreasing, discharge destination after surgery can serve as an important metric for quality of care. Additionally, patients desire information on possible discharge destination. Adequate planning requires a multidisciplinary approach, can reduce healthcare costs and ensure patient needs are met.

Refining the predictive variables in the "Surgical Risk Preoperative Assessment System" (SURPAS): a descriptive analysis.

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.

Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator.

Background: The novel Surgical Risk Preoperative Assessment System (SURPAS) requires entry of five predictor variables (the other three variables of the eight-variable model are automatically obtained from the electronic health record or a table look-up), provides patient risk estimates compared to national averages, is integrated into the electronic health record, and provides a graphical handout of risks for patients. The accuracy of the SURPAS tool was compared to that of the American College of Surgeons Surgical Risk Calculator (ACS-SRC).

Methods: Predicted risk of postoperative mortality and morbidity was calculated using both SURPAS and ACS-SRC for 1,006 randomly selected 2007-2016 ACS National Surgical Quality Improvement Program (NSQIP) patients with known outcomes.

Accurate preoperative prediction of unplanned 30-day postoperative readmission using 8 predictor variables.

Background: Unplanned postoperative readmissions are associated with high costs, may indicate poor care quality, and present a substantial opportunity for healthcare quality improvement. Patients want to know their risk of unplanned readmission, and surgeons need to know the risk to adequately counsel their patients. The Surgical Risk Preoperative Assessment System tool was developed from the American College of Surgeons National Surgical Quality Improvement Program dataset and is a parsimonious model using 8 predictor variables.

Use of the consolidated framework for implementation research to guide dissemination and implementation of new technologies in surgery.

Background: Improving surgical outcomes is important to patients, providers, and healthcare systems. Understanding best methods to ensure evidence based practices are successfully implemented and sustained in clinical practices leads to improved care. Dissemination and implementation (D&I) science facilitates the successful pathway from clinical trials to sustained implementation.

Assessment of attitudes towards future implementation of the "Surgical Risk Preoperative Assessment System" (SURPAS) tool: a pilot survey among patients, surgeons, and hospital administrators.

Background: Risk assessment in surgery is essential to guide treatment decisions but is highly variable in practice. Providing formal preoperative risk assessment to surgical teams and patients may optimize understanding of risk. Implementation of the Surgical Risk Preoperative Assessment System (SURPAS), an innovative real time, universal, preoperative tool providing individualized risk assessment, may enhance informed consent and reduce adverse outcomes.

Temporal Trends, Determinants, and Outcomes of Inpatient versus Outpatient Arteriovenous Fistula Operations.

Background: As high healthcare costs are increasing scrutinized, a movement toward reducing patient hospital admissions and lengths of stay has emerged, particularly for operations that may be performed safely in the outpatient setting. Our aim is to describe recent temporal trends in the proportion of dialysis access procedures performed on an inpatient versus outpatient basis and to determine the effects of these changes on perioperative morbidity and mortality.

Methods: The 2005-2008 American College of Surgeons National Surgical Quality Improvement Program database was queried for all primary arteriovenous fistula (AVF) procedures using current procedural terminology codes.

Intermediate-Acting Nondepolarizing Neuromuscular Blocking Agents and Risk of Postoperative 30-Day Morbidity and Mortality, and Long-term Survival.

Background: Nondepolarizing neuromuscular blocking drugs (NNMBDs) are commonly used as an adjunct to general anesthesia. Residual blockade is common, but its potential adverse effects are incompletely known. This study was designed to assess the association between NNMBD use with or without neostigmine reversal and postoperative morbidity and mortality.

An institutional analysis of unplanned return to the operating room to identify areas for quality improvement.

Background: Unplanned return to the operating room (uROR) has been suggested as a hospital quality indicator. The purpose of this study was to determine reasons for uROR to identify opportunities for patient care improvement.

Methods: uROR reported by our institution's American College of Surgeons National Surgical Quality Improvement Program underwent secondary review.

Operative variables are better predictors of postdischarge infections and unplanned readmissions in vascular surgery patients than patient characteristics.

Objective: Although postoperative readmissions are frequent in vascular surgery patients, the reasons for these readmissions are not well characterized, and effective approaches to their reduction are unknown. Our aim was to analyze the reasons for vascular surgery readmissions and to report potential areas for focused efforts aimed at readmission reduction.

Methods: The 2012 to 2013 American College of Surgeons National Quality Improvement Program (ACS NSQIP) data set was queried for vascular surgery patients.

Drivers of readmissions in vascular surgery patients.

Objective: Postoperative readmissions are frequent in vascular surgery patients, but it is not clear which factors are the main drivers of readmissions. Specifically, the relative contributions of patient comorbidities vs those of operative factors and postoperative complications are unknown. We sought to study the multiple potential drivers of readmission and to create a model for predicting the risk of readmission in vascular patients.

Surgical Risk Preoperative Assessment System (SURPAS): I. Parsimonious, Clinically Meaningful Groups of Postoperative Complications by Factor Analysis.

Objective: To use factor analysis to cluster the 18 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) perioperative complications into a reproducible, smaller number of clinically meaningful groups of postoperative complications, facilitating and streamlining future study and application in live clinical settings.

Background: The ACS NSQIP collects and reports on eighteen 30-day postoperative complications (excluding mortality), which are variably grouped in published analyses using ACS NSQIP data. This hinders comparison between studies of this widely used quality improvement dataset.