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. 2012 Fall;16(4):10-7.
doi: 10.7812/TPP/12-019.

Predicting risk of death in general surgery patients on the basis of preoperative variables using American College of Surgeons National Surgical Quality Improvement Program data

Sachin Vaid  1 , Ted Bell, Rod Grim, Vanita Ahuja
Affiliations

Predicting risk of death in general surgery patients on the basis of preoperative variables using American College of Surgeons National Surgical Quality Improvement Program data

Sachin Vaid et al. Perm J. 2012 Fall.

Abstract

Objectives: To use the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database to develop an accurate and clinically meaningful preoperative mortality predictor (PMP) for general surgery on the basis of objective information easily obtainable at the patient's bedside and to compare it with the preexisting NSQIP mortality predictor (NMP).

Methods: Data were obtained from the ACS NSQIP Participant Use Data File (2005 to 2008) for current procedural terminology codes that included open pancreas surgery and open/laparoscopic colorectal, hernia (ventral, umbilical, or inguinal), and gallbladder surgery. Chi-square analysis was conducted to determine which preoperative variables were significantly associated with death. Logistic regression followed by frequency analysis was conducted to assign weight to these variables. PMP score was calculated by adding the scores for contributing variables and was applied to 2009 data for validation. The accuracy of PMP score was tested with correlation, logistic regression, and receiver operating characteristic analysis.

Results: PMP score was based on 16 variables that were statistically reliable in distinguishing between surviving and dead patients (p < 0.05). Statistically significant variables predicting death were inpatient status, sepsis, poor functional status, do-not-resuscitate directive, disseminated cancer, age, comorbidities (cardiac, renal, pulmonary, liver, and coagulopathy), steroid use, and weight loss. The model correctly classified 98.6% of patients as surviving or dead (p < 0.05). Spearman correlation of the NMP and PMP was 86.9%.

Conclusion: PMP score is an accurate and simple tool for predicting operative survival or death using only preoperative variables that are readily available at the bedside. This can serve as a performance assessment tool between hospitals and individual surgeons.

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Figures

Figure 1
Figure 1
Correlation between preoperative mortality predictor and National Surgical Quality Improvement Program (NSQIP) mortality predictor. NMP = NSQIP mortality predictor; PMP = preoperative mortality predictor.
Figure 2
Figure 2
Receiver operating characteristic curve to test preoperative mortality predictor.
Figure 3
Figure 3
Percentage of mortality within each group.
See this image and copyright information in PMC

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