IMPORTANCE: No consensus exists regarding the definition of high-risk surgery in older adults. An inclusive and precise definition of high-risk surgery may be useful for surgeons, patients, researchers, and hospitals. OBJECTIVE: To develop a list of high-risk operations. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study and modified Delphi procedure. The setting included all Pennsylvania acute care hospitals (Pennsylvania Health Care Cost Containment Council [PHC4] April 1, 2001, to December 31, 2007) and a nationally representative sample of US acute care hospitals (Nationwide Inpatient Sample [NIS], Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality January 1, 2001, to December 31, 2006). Patients included were those 65 years and older admitted to PHC4 hospitals and those 18 years and older admitted to NIS hospitals. We identified International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes associated with at least 1% inpatient mortality in the PHC4. We used a modified Delphi procedure with 5 board-certified surgeons to further refine this list by excluding nonoperative procedures and operations that were unlikely to be the proximate cause of mortality and were instead a marker of critical illness (eg, tracheostomy). We then cross-validated this list of ICD-9-CM codes in the NIS. MAIN OUTCOMES AND MEASURES: Modified Delphi procedure consensus of at least 4 of 5 panelists and proportion agreement in the NIS. RESULTS: Among 4,739,522 admissions of patients 65 years and older in the PHC4, a total of 2,569,589 involved a procedure, encompassing 2853 unique procedures. Of 1130 procedures associated with a crude inpatient mortality of at least 1%, 264 achieved consensus as high-risk operations by the modified Delphi procedure. The observed inpatient mortality in the NIS was at least 1% for 227 of 264 procedures (86%) in patients 65 years and older. The pooled inpatient mortality for these identified high-risk procedures performed on patients 65 years and older was double the pooled inpatient mortality for correspondingly identified high-risk operations for patients younger than 65 years (6% vs 3%). CONCLUSIONS AND RELEVANCE: We developed a list of procedure codes to identify high-risk surgical procedures in claims data. This list of high-risk operations can be used to standardize the definition of high-risk surgery in quality and outcomes-based studies and to design targeted clinical interventions.
IMPORTANCE: No consensus exists regarding the definition of high-risk surgery in older adults. An inclusive and precise definition of high-risk surgery may be useful for surgeons, patients, researchers, and hospitals. OBJECTIVE: To develop a list of high-risk operations. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study and modified Delphi procedure. The setting included all Pennsylvania acute care hospitals (Pennsylvania Health Care Cost Containment Council [PHC4] April 1, 2001, to December 31, 2007) and a nationally representative sample of US acute care hospitals (Nationwide Inpatient Sample [NIS], Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality January 1, 2001, to December 31, 2006). Patients included were those 65 years and older admitted to PHC4 hospitals and those 18 years and older admitted to NIS hospitals. We identified International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes associated with at least 1% inpatient mortality in the PHC4. We used a modified Delphi procedure with 5 board-certified surgeons to further refine this list by excluding nonoperative procedures and operations that were unlikely to be the proximate cause of mortality and were instead a marker of critical illness (eg, tracheostomy). We then cross-validated this list of ICD-9-CM codes in the NIS. MAIN OUTCOMES AND MEASURES: Modified Delphi procedure consensus of at least 4 of 5 panelists and proportion agreement in the NIS. RESULTS: Among 4,739,522 admissions of patients 65 years and older in the PHC4, a total of 2,569,589 involved a procedure, encompassing 2853 unique procedures. Of 1130 procedures associated with a crude inpatient mortality of at least 1%, 264 achieved consensus as high-risk operations by the modified Delphi procedure. The observed inpatient mortality in the NIS was at least 1% for 227 of 264 procedures (86%) in patients 65 years and older. The pooled inpatient mortality for these identified high-risk procedures performed on patients 65 years and older was double the pooled inpatient mortality for correspondingly identified high-risk operations for patients younger than 65 years (6% vs 3%). CONCLUSIONS AND RELEVANCE: We developed a list of procedure codes to identify high-risk surgical procedures in claims data. This list of high-risk operations can be used to standardize the definition of high-risk surgery in quality and outcomes-based studies and to design targeted clinical interventions.
Authors: T H Lee; E R Marcantonio; C M Mangione; E J Thomas; C A Polanczyk; E F Cook; D J Sugarbaker; M C Donaldson; R Poss; K K Ho; L E Ludwig; A Pedan; L Goldman Journal: Circulation Date: 1999-09-07 Impact factor: 29.690
Authors: Shukri F Khuri; William G Henderson; Ralph G DePalma; Cecilia Mosca; Nancy A Healey; Dharam J Kumbhani Journal: Ann Surg Date: 2005-09 Impact factor: 12.969
Authors: Rebecca L Sudore; Kristine Yaffe; Suzanne Satterfield; Tamara B Harris; Kala M Mehta; Eleanor M Simonsick; Anne B Newman; Caterina Rosano; Ronica Rooks; Susan M Rubin; Hilsa N Ayonayon; Dean Schillinger Journal: J Gen Intern Med Date: 2006-08 Impact factor: 5.128
Authors: Martin A Makary; Dorry L Segev; Peter J Pronovost; Dora Syin; Karen Bandeen-Roche; Purvi Patel; Ryan Takenaga; Lara Devgan; Christine G Holzmueller; Jing Tian; Linda P Fried Journal: J Am Coll Surg Date: 2010-04-28 Impact factor: 6.113
Authors: G J L'Italien; S D Paul; R C Hendel; J A Leppo; M C Cohen; L A Fleisher; K A Brown; S W Zarich; R P Cambria; B S Cutler; K A Eagle Journal: J Am Coll Cardiol Date: 1996-03-15 Impact factor: 24.094
Authors: Rupert M Pearse; David A Harrison; Philip James; David Watson; Charles Hinds; Andrew Rhodes; R Michael Grounds; E David Bennett Journal: Crit Care Date: 2006-06-02 Impact factor: 9.097
Authors: Shawna Amini; Samuel Crowley; Loren Hizel; Franchesca Arias; David J Libon; Patrick Tighe; Chris Giordano; Cynthia W Garvan; F Kayser Enneking; Catherine C Price Journal: Anesth Analg Date: 2019-09 Impact factor: 5.108
Authors: Jill Q Dworsky; Christopher P Childers; Jeffrey Gornbein; Melinda Maggard-Gibbons; Marcia M Russell Journal: Surgery Date: 2019-09-10 Impact factor: 3.982
Authors: Nicole M Steffens; Jennifer L Tucholka; Michael J Nabozny; Andrea E Schmick; Karen J Brasel; Margaret L Schwarze Journal: JAMA Surg Date: 2016-10-01 Impact factor: 14.766
Authors: Victoria L Tang; Bocheng Jing; John Boscardin; Sarah Ngo; Molly Silvestrini; Emily Finlayson; Kenneth E Covinsky Journal: JAMA Surg Date: 2020-05-01 Impact factor: 14.766
Authors: Amol S Navathe; Victor J Lei; Lee A Fleisher; ThaiBinh Luong; Xinwei Chen; Edward Kennedy; Kevin G Volpp; Daniel E Polsky; Peter W Groeneveld; Mark Weiner; John H Holmes; Mark D Neuman Journal: J Hosp Med Date: 2020-10 Impact factor: 2.960
Authors: Michael J Nabozny; Amber E Barnato; Paul J Rathouz; Jeffrey A Havlena; Amy J Kind; William J Ehlenbach; Qianqian Zhao; Katie Ronk; Maureen A Smith; Caprice C Greenberg; Margaret L Schwarze Journal: Crit Care Med Date: 2016-06 Impact factor: 7.598
Authors: Tyler R Chesney; Barbara Haas; Natalie G Coburn; Alyson L Mahar; Victoria Zuk; Haoyu Zhao; Amy T Hsu; Julie Hallet Journal: Ann Surg Oncol Date: 2020-08-12 Impact factor: 5.344