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Risk Prediction Accuracy Differs for Emergency Versus Elective Cases in the ACS-NSQIP
Joseph A Hyder1, Gally Reznor, Elliot Wakeam
1*Department of Anesthesiology and Division of Respiratory and Critical Care Medicine, Mayo Clinic, Rochester, MN†Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN‡Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA§Department of Surgery, University of Toronto, Toronto, Ontario, Canada¶Department of Medicine, Brigham and Women's Hospital, Boston, MA||Department of Surgery, Brigham and Women's Hospital, Boston, MA**Harvard Medical School, Boston, MA.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk models show different mortality predictions for emergency versus elective surgery patients. These disparities impact surgical outcome benchmarking and shared decision-making.
Area of Science:
- Surgical outcomes research
- Health services research
- Medical informatics
Background:
- Accurate surgical risk estimation is crucial for fair benchmarking and informed patient decisions.
- Emergency surgery patients' complexity may skew comparisons with elective cases.
Purpose of the Study:
- To evaluate if the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk model predicts mortality equally for emergency and elective surgical patients.
Main Methods:
- Analysis of ACS-NSQIP 2011-2012 data for common gastrointestinal, vascular, and hepato-biliary-pancreatic procedures.
- Comparison of ACS-NSQIP predicted mortality using observed-to-expected ratios, c-statistics, and Brier scores in matched emergency and elective patient cohorts.
Main Results:
- Observed-to-expected mortality ratios and c-statistics significantly differed between emergency and elective patient groups.
- Brier scores showed significant differences at low mortality rates (1.7%) but not at higher rates (6.5%-9%).
Conclusions:
- ACS-NSQIP risk predictions demonstrate disparities between emergency and elective surgical populations.
- These differences may affect the reliability of ACS-NSQIP for benchmarking and shared decision-making in diverse surgical settings.
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