Advertisement
Trauma/Critical Care| Volume 168, ISSUE 6, P1152-1159, December 2020

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

  • Paul D. Rozeboom
    Correspondence
    Reprint requests: Paul D. Rozeboom, MD, University of Colorado Department of Surgery, Academic Office One, 12631 East 17th Avenue, C-305, Aurora, CO, 80045.
    Affiliations
    Department of Surgery, University of Colorado School of Medicine, Aurora, CO

    Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO
    Search for articles by this author
  • Michael R. Bronsert
    Affiliations
    Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO

    Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
    Search for articles by this author
  • Catherine G. Velopulos
    Affiliations
    Department of Surgery, University of Colorado School of Medicine, Aurora, CO

    Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO
    Search for articles by this author
  • William G. Henderson
    Affiliations
    Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO

    Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO

    Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
    Search for articles by this author
  • Kathryn L. Colborn
    Affiliations
    Department of Surgery, University of Colorado School of Medicine, Aurora, CO

    Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO
    Search for articles by this author
  • Karl E. Hammermeister
    Affiliations
    Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO

    Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO

    Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO
    Search for articles by this author
  • Anne Lambert-Kerzner
    Affiliations
    Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO

    Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
    Search for articles by this author
  • Mark G. Hall
    Affiliations
    Department of Surgery, University of Colorado School of Medicine, Aurora, CO

    University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR
    Search for articles by this author
  • Robert C. McIntyre Jr.
    Affiliations
    Department of Surgery, University of Colorado School of Medicine, Aurora, CO
    Search for articles by this author
  • Robert A. Meguid
    Affiliations
    Department of Surgery, University of Colorado School of Medicine, Aurora, CO

    Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO

    Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
    Search for articles by this author
Published:September 05, 2020DOI:https://doi.org/10.1016/j.surg.2020.07.029

      Abstract

      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. Risk estimates were compared with known outcomes. Analyses included the Hosmer-Lemeshow goodness of fit graphs and P values, c-indexes, and Brier scores.

      Results

      Results were similar between the Surgical Risk Preoperative Assessment System and the American College of Surgeons Surgical Risk Calculator for mortality, urinary tract infection, cardiac, venous thromboembolism, and renal complications. The American College of Surgeons Surgical Risk Calculator underestimated morbidity compared with the Surgical Risk Preoperative Assessment System (16.04% American College of Surgeons Surgical Risk Calculator vs 24.88% Surgical Risk Preoperative Assessment System vs 24.3% observed). Both calculators overestimated readmission (7.67% American College of Surgeons Surgical Risk Calculator vs 5.18% Surgical Risk Preoperative Assessment System vs 4.1% observed).

      Conclusion

      Both calculators predicted mortality, urinary tract infection, cardiac, venous thromboembolism, and renal complications well, but readmissions relatively poorly. The Surgical Risk Preoperative Assessment System estimated overall morbidity accurately, while the American College of Surgeons Surgical Risk Calculator underestimated this risk.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nag D.S.
        Assessing the risk: Scoring systems for outcome prediction in emergency laparotomies.
        Biomedicine (Taipei). 2015; 5: 20
        • Hammermeister K.E.
        • Henderson W.G.
        • Bronsert M.R.
        • Juarez-Colunga E.
        • Meguid R.A.
        Bringing quantitative risk assessment closer to the patient and surgeon: a novel approach to improve outcomes.
        Ann Surg. 2016; 263: 1039-1041
        • Havens J.M.
        • Columbus A.B.
        • Seshadri A.J.
        • et al.
        Risk stratification tools in emergency general surgery.
        Trauma Surg Acute Care Open. 2018; 3e000160
        • Nandan A.R.
        • Bohnen J.D.
        • Sangji N.F.
        • et al.
        The Emergency Surgery Score (ESS) accurately predicts the occurrence of postoperative complications in emergency surgery patients.
        J Trauma Acute Care Surg. 2017; 83: 84-89
        • Sangji N.F.
        • Bohnen J.D.
        • Ramly E.P.
        • et al.
        Derivation and validation of a novel Emergency Surgery Acuity Score (ESAS).
        J Trauma Acute Care Surg. 2016; 81: 213-220
        • Leeds I.L.
        • Jones C.
        • DiBrito S.R.
        • Sakran J.V.
        • Haut E.R.
        • Kent A.J.
        Delay in emergency hernia surgery is associated with worse outcomes.
        Surg Endosc. 2020; 34: 4562-4573
        • Ong M.
        • Guang T.Y.
        • Yang T.K.
        Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: a single center experience.
        World J Gastrointest Surg. 2015; 7: 208-213
        • van Dijk S.T.
        • van Dijk A.H.
        • Dijkgraaf M.G.
        • Boermeester M.A.
        Meta-analysis of in-hospital delay before surgery as a risk factor for complications in patients with acute appendicitis.
        Br J Surg. 2018; 105: 933-945
        • Khaneki S.
        • Bronsert M.R.
        • Henderson W.G.
        • et al.
        Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator.
        Am J Surg. 2019; 219: 1065-1072
        • Meguid R.A.
        • Bronsert M.R.
        • Juarez-Colunga E.
        • Hammermeister K.E.
        • Henderson W.G.
        Surgical Risk Preoperative Assessment System (SURPAS): I. Parsimonious, clinically meaningful groups of postoperative complications by factor analysis.
        Ann Surg. 2016; 263: 1042-1048
        • Meguid R.A.
        • Bronsert M.R.
        • Juarez-Colunga E.
        • Hammermeister K.E.
        • Henderson W.G.
        Surgical Risk Preoperative Assessment System (SURPAS): II. Parsimonious risk models for postoperative adverse outcomes addressing need for laboratory variables and surgeon specialty-specific models.
        Ann Surg. 2016; 264: 10-22
        • Meguid R.A.
        • Bronsert M.R.
        • Juarez-Colunga E.
        • Hammermeister K.E.
        • Henderson W.G.
        Surgical Risk Preoperative Assessment System (SURPAS): III. Accurate preoperative prediction of 8 adverse outcomes using 8 predictor variables.
        Ann Surg. 2016; 264: 23-31
        • American College of Surgeons
        ACS NSQIP Surgical Risk Calculator; 2019.
        (Accessed September 30, 2019)
        • American College of Surgeons
        User Guide for the 2017 ACS NSQIP Participant Use Data File (PUF); 2018.
        (Accessed September 24, 2019)
        • Austin P.C.
        • Steyerberg E.W.
        Events per variable (EPV) and the relative performance of different strategies for estimating the out-of-sample validity of logistic regression models.
        Stat Methods Med Res. 2017; 26: 796-808
        • Glasgow R.E.
        • Hawn M.T.
        • Hosokawa P.W.
        • et al.
        Comparison of prospective risk estimates for postoperative complications: human vs computer model.
        J Am Coll Surg. 2014; 218 (e1-4): 237-245
        • Ingraham A.M.
        • Cohen M.E.
        • Raval M.V.
        • Ko C.Y.
        • Nathens A.B.
        Variation in quality of care after emergency general surgery procedures in the elderly.
        J Am Coll Surg. 2011; 212: 1039-1048
        • Lubitz A.L.
        • Chan E.
        • Zarif D.
        • et al.
        American College of Surgeons NSQIP Risk Calculator accuracy for emergent and elective colorectal operations.
        J Am Coll Surg. 2017; 225: 601-611
        • Sudarshan M.
        • Feldman L.S.
        • St Louis E.
        • et al.
        Predictors of mortality and morbidity for acute care surgery patients.
        J Surg Res. 2015; 193: 868-873
        • Neary W.D.
        • Prytherch D.
        • Foy C.
        • Heather B.P.
        • Earnshaw J.J.
        Comparison of different methods of risk stratification in urgent and emergency surgery.
        Br J Surg. 2007; 94: 1300-1305
        • Oliver C.M.
        • Walker E.
        • Giannaris S.
        • Grocott M.P.
        • Moonesinghe S.R.
        Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review.
        Br J Anaesth. 2015; 115: 849-860
        • Stonelake S.
        • Thomson P.
        • Suggett N.
        Identification of the high risk emergency surgical patient: which risk prediction model should be used?.
        Ann Med Surg (Lond). 2015; 4: 240-247
        • Cohen M.E.
        • Liu Y.
        • Ko C.Y.
        • Hall B.L.
        An examination of American College of Surgeons NSQIP Surgical Risk Calculator accuracy.
        J Am Coll Surg. 2017; 224: 787-795.e1
        • The University of Colorado School of Medicine, Division of Cardiothoracic Surgery
        Surgical Risk Preoperative Assessment System; 2019.
        (Accessed October 25, 2019)
        • Jawaid M.
        • Farhan M.
        • Masood Z.
        • Husnain S.
        Preoperative informed consent: is it truly informed?.
        Iran J Public Health. 2012; 41: 25-30
        • Lambert-Kerzner A.
        • Ford K.L.
        • Hammermeister K.E.
        • Henderson W.G.
        • Bronsert M.R.
        • Meguid R.A.
        Assessment of attitudes towards future implementation of the “Surgical Risk Preoperative Assessment System” (SURPAS) tool: a pilot survey among patients, surgeons, and hospital administrators.
        Patient Saf Surg. 2018; 12: 12
        • Meredyth N.A.
        • de Melo-Martin I.
        (Under)valuing surgical informed consent.
        J Am Coll Surg. 2020; 230: 257-262
        • Aggarwal G.
        • Peden C.J.
        • Mohammed M.A.
        • et al.
        • and the Emergeny Laparotomy Collaborative
        Evaluation of the collaborative use of an evidence-based care bundle in emergency laparotomy.
        JAMA Surg. 2019; 154e190145