Preoperative Surgical Risk Predictions Are Not Meaningfully Improved by Including the Surgical Apgar Score: An Analysis of the Risk Quantification Index and Present-On-Admission Risk Models

Anesthesiology
Maxim A TerekhovJonathan P Wanderer

Abstract

Estimating surgical risk is critical for perioperative decision making and risk stratification. Current risk-adjustment measures do not integrate dynamic clinical parameters along with baseline patient characteristics, which may allow a more accurate prediction of surgical risk. The goal of this study was to determine whether the preoperative Risk Quantification Index (RQI) and Present-On-Admission Risk (POARisk) models would be improved by including the intraoperative Surgical Apgar Score (SAS). The authors identified adult patients admitted after noncardiac surgery. The RQI and POARisk were calculated using published methodologies, and model performance was compared with and without the SAS. Relative quality was measured using Akaike and Bayesian information criteria. Calibration was compared by the Brier score. Discrimination was compared by the area under the receiver operating curves (AUROCs) using a bootstrapping procedure for bias correction. SAS alone was a statistically significant predictor of both 30-day mortality and in-hospital mortality (P < 0.0001). The RQI had excellent discrimination with an AUROC of 0.8433, which increased to 0.8529 with the addition of the SAS. The POARisk had excellent discrimination with an...Continue Reading

References

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Jan 27, 2007·Journal of the American College of Surgeons·Atul A GawandeMichael J Zinner
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Dec 10, 2013·Journal of the American College of Surgeons·Marcovalerio MelisThomas H Gouge

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Citations

Aug 23, 2017·Journal of Clinical Monitoring and Computing·Clemence PetitLouis Atallah
Apr 20, 2016·Anesthesiology·Maxim A TerekhovJonathan P Wanderer
Aug 19, 2016·Current Opinion in Anaesthesiology·Teus H Kappen, Linda M Peelen
Apr 20, 2016·Anesthesiology·Joseph A Hyder

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