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The usefulness of the surgeon's perception quantified by visual analog scale in predicting postoperative prognosis
Saeko Fukui1, Akira Yoneda1, Hiroaki Takeshita1
1Department of Surgery, NHO Nagasaki Medical Center, Omura, Nagasaki, Japan.
Background:
Traditional postoperative prognostic indicators rely primarily on objective measures, such as patient characteristics and operative indices, potentially missing important clinical insights that surgeons develop through experience. We investigated whether surgeons' subjective perceptions quantified using a visual analog scale serve as valuable predictors of postoperative outcomes.
Methods:
This prospective cohort study was conducted at a tertiary hospital over 2 consecutive periods (2023 and 2024). Patients undergoing general surgical procedures were enrolled, with the 2023 cohort (n = 296) serving as the development data set and the 2024 cohort (n = 171) serving as the validation cohort. Primary and assistant surgeons completed visual analog scale assessments (0-100 scale) for multiple aspects of the surgical case both preoperatively and postoperatively. The primary outcome was the occurrence of Clavien-Dindo grade III or higher complications (≥Clavien-Dindo grade III).
Results:
In the 2023 cohort, 10.1% of patients experienced ≥Clavien-Dindo grade III complications, and 12.3% in the 2024 validation cohort. Surgeons' preoperative assessment of the patient's basic general condition (Q4) emerged as the strongest independent predictor of severe complications in the multivariable analysis (odds ratio, 1.35 per 10-unit increase; 95% confidence interval, 1.12-1.63; P = .002). A risk prediction model incorporating age, emergency status, blood loss, and the surgeon's Q4 assessment demonstrated good discrimination (area under the curve, 0.777). The model maintained a similar performance in the validation cohort (area under the curve, 0.774).
Conclusion:
Surgeons' subjective assessments, particularly their preoperative evaluation of patients' general condition, provide valuable prognostic information. These assessments may capture important clinical insights not reflected in conventional scoring systems and enhance perioperative risk stratification.
