Use of risk assessment tools in emergency general surgery: a cross-sectional survey of surgeons and trainees

The applicability of risk assessment tools (RATs) for preoperative risk assessment (PRA) in Emergency General Surgery (EGS) is unclear. Limited knowledge of surgeons' approach to risk assessment is available. We investigated how Canadian surgeons approach PRA for EGS and their awareness of available RATs. Canadian Association of General Surgeons members were invited to complete an online cross-sectional survey. Descriptive statistics were reported. Of 278 respondents, 70% were attending surgeons (44% had 5-10 years in practice, 43% > 10 years), 5% fellows, and 25% residents. Most worked in medium-/large-volume centers (89%) and teaching hospitals (77%). During preoperative risk assessment, 2/3 of respondents reported applying clinical experience/instinct and referring to literature, while 55% used RATs. The best-known and used tools were the ACS-NSQIP calculator (68% and 59%) and the Emergency Surgery Acuity Score (ESAS, 66% and 47%, respectively). Surgeons were divided regarding the accuracy of RAT estimates, with 47% considering them generally accurate and 49% inaccurate. Trainees reported greater interest in major morbidity risk (86% vs. 65%) and probability of supported discharge (45% vs. 29%) than surgeons. Among participants not using RATs, 41% indicated they are scarcely accessible in the EGS context, while 33% found them cumbersome and time-consuming. RATs are underused in favor of personal judgment. The use of RATs may facilitate decision-making in elderly/complex patients and help reduce variability in practice, particularly for trainees and less-experienced surgeons. A greater effort in education is needed to spread the culture of RATs for PRA.