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. 2025 Jan 27;25(1):33.
doi: 10.1186/s12871-024-02880-4.

Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery

Edward N Yap  1   2 , Jie Huang  3 , Joshua Chiu  4 , Robert W Chang  3   5 , Bradley Cohn  6 , Judith C F Hwang  7 , Mary Reed  3
Affiliations

Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery

Edward N Yap et al. BMC Anesthesiol. .

Abstract

Background: Clinical determination of patients at high risk of poor surgical outcomes is complex and may be supported by clinical tools to summarize the patient's own personalized electronic health record (EHR) history and vitals data through predictive risk models. Since prior models were not readily available for EHR-integration, our objective was to develop and validate a risk stratification tool, named the Assessment of Geriatric Emergency Surgery (AGES) score, predicting risk of 30-day major postoperative complications in geriatric patients under consideration for urgent and emergency surgery using pre-surgical existing electronic health record (EHR) data.

Methods: Patients 65-years and older undergoing urgent or emergency non-cardiac surgery within 21 hospitals 2017-2021 were used to develop the model (randomly split: 80% training, 20% test). The primary outcome was a 30-day composite outcome including several postoperative major complications and mortality; secondary outcomes included common individual complications included in the primary composite outcome (sepsis, progressive renal insufficiency or renal failure, and mortality). Patients' EHR-based clinical history, vital signs, labs, and demographics were included in logistic regression, LASSO, decision tree, Random Forest, and XGBoost models. Area under the receiver operating characteristics curve (AUCROC) was used to compare model performance.

Results: Overall, 66,262 patients (median [IQR] age 78 [(70.9-84.0], female 53.9%, White race 68.5%) received urgent or emergency non-cardiac surgery (25.7% orthopedic cases, 21.9% general surgery cases). AUCROC ranged from 0.655 (Decision Tree) - 0.804 (XGBoost) for the primary composite outcome. XGBoost AUCROC was 0.823, 0.781, and 0.839 in predicting outcomes of sepsis, progressive renal insufficiency or renal failure, and mortality, respectively.

Conclusions: We developed a model to accurately predict major postoperative complications in geriatric patients undergoing urgent or emergency surgery using the patient's own existing EHR data. EHR implementation of this model could efficiently support clinicians' surgical risk assessment and perioperative decision-making discussions in this vulnerable patient population.

Keywords: Emergency surgery; Geriatric surgery; Risk prediction model.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was performed in accordance with the ethical principles of the Belmont Report. This study was approved by the Kaiser Foundation Institute’s Institutional Review Board (1900880–5) and the requirement for written informed consent was waived. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC Curve: composite 30-day postoperative major complications and mortality
Fig. 2
Fig. 2
Precision Recall Curve: composite 30-day postoperative major complications and mortality
Fig. 3
Fig. 3
Calibration Curve: composite 30-day postoperative major complications and mortality (XGBoost)
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