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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
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Development and Validation of an Electronic Postoperative Morbidity Score
Daniel J Stubbs1, Jessica L Bowen1, Rachel C Furness1
1From the University Division of Anaesthesia.
Anesthesia and Analgesia
|December 4, 2018
Summary
An electronic postoperative morbidity score was developed for electronic health records. This new score demonstrated comparable predictive ability to the traditional score for patient discharge outcomes.
Area of Science:
- Medical Informatics
- Surgical Outcomes Research
- Health Data Analytics
Background:
- Electronic health records (EHRs) offer benefits but require objective morbidity metrics.
- Developing EHR-integrated tools is crucial for consistent patient care assessment.
- Traditional morbidity scores need adaptation for digital health environments.
Purpose of the Study:
- To develop an electronic version of the postoperative morbidity score (ePOMS).
- To integrate ePOMS into existing electronic health record systems.
- To evaluate the ePOMS's ability to characterize patient morbidity objectively.
Main Methods:
- Retrospective review of 203 frail patients undergoing elective surgery.
- Defined postoperative morbidity score (POMS) on postoperative day 3.
- Developed and refined electronic surrogates for morbidity extraction within the EHR.
- Compared discriminative capability of ePOMS vs. POMS for prolonged length of stay and complex discharge.
Main Results:
- 68% of patients exhibited morbidity by POMS criteria.
- Initial electronic surrogates were overly sensitive (84% identified morbidity).
- Refined ePOMS showed no significant difference in discriminative capability compared to POMS (AUCs ~0.66-0.67).
- Both POMS and ePOMS identified patients at increased risk for prolonged length of stay (P < .001).
Conclusions:
- An electronic postoperative morbidity score (ePOMS) was developed using objective EHR metrics.
- ePOMS demonstrated comparable discriminative performance to gold-standard POMS for discharge outcomes.
- ePOMS facilitates morbidity characterization within EHRs, though external validation is needed.
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