Paul D Rozeboom1, Michael R Bronsert2, William G Henderson3, Catherine G Velopulos4, Kathryn L Colborn5, Anne Lambert-Kerzner6, Robert C McIntyre7, Robert A Meguid8. 1. Department of Surgery Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: paul.rozeboom@cuanschutz.edu. 2. Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: michael.bronsert@cuanschutz.edu. 3. Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA. Electronic address: william.henderson@cuanschutz.edu. 4. Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA; Department of Surgery Division of GI, Endocrine, and Trauma Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: catherine.velopulos@cuanschutz.edu. 5. Department of Surgery Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: kathryn.colborn@cuanschutz.edu. 6. Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA. Electronic address: anne.lambert-kerzner@cuanschutz.edu. 7. Department of Surgery Division of GI, Endocrine, and Trauma Surgery, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: robert.mcintyre@cuanschutz.edu. 8. Department of Surgery Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, CO, USA; Surgical Outcomes and Applied Research Program, University of Colorado School of Medicine, Aurora, CO, USA; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: robert.meguid@cuanschutz.edu.
Abstract
BACKGROUND: The Surgical Risk Preoperative Assessment System (SURPAS) uses eight variables to accurately predict postoperative complications but has not been sufficiently studied in emergency surgery. We evaluated SURPAS in emergency surgery, comparing it to the Emergency Surgery Score (ESS). METHODS: SURPAS and ESS estimates of 30-day mortality and overall morbidity were calculated for emergency operations in the 2009-2018 ACS-NSQIP database and compared using observed-to-expected plots and rates, c-indices, and Brier scores. Cases with incomplete data were excluded. RESULTS: In 205,318 emergency patients, SURPAS underestimated (8.1%; 35.9%) while ESS overestimated (10.1%; 43.8%) observed mortality and morbidity (8.9%; 38.8%). Each showed good calibration on observed-to-expected plots. SURPAS had better c-indices (0.855 vs 0.848 mortality; 0.802 vs 0.755 morbidity), while the Brier score was better for ESS for mortality (0.0666 vs. 0.0684) and for SURPAS for morbidity (0.1772 vs. 0.1950). CONCLUSIONS: SURPAS accurately predicted mortality and morbidity in emergency surgery using eight predictor variables.
BACKGROUND: The Surgical Risk Preoperative Assessment System (SURPAS) uses eight variables to accurately predict postoperative complications but has not been sufficiently studied in emergency surgery. We evaluated SURPAS in emergency surgery, comparing it to the Emergency Surgery Score (ESS). METHODS: SURPAS and ESS estimates of 30-day mortality and overall morbidity were calculated for emergency operations in the 2009-2018 ACS-NSQIP database and compared using observed-to-expected plots and rates, c-indices, and Brier scores. Cases with incomplete data were excluded. RESULTS: In 205,318 emergency patients, SURPAS underestimated (8.1%; 35.9%) while ESS overestimated (10.1%; 43.8%) observed mortality and morbidity (8.9%; 38.8%). Each showed good calibration on observed-to-expected plots. SURPAS had better c-indices (0.855 vs 0.848 mortality; 0.802 vs 0.755 morbidity), while the Brier score was better for ESS for mortality (0.0666 vs. 0.0684) and for SURPAS for morbidity (0.1772 vs. 0.1950). CONCLUSIONS: SURPAS accurately predicted mortality and morbidity in emergency surgery using eight predictor variables.
Authors: Nisha Pradhan; Adam R Dyas; Michael R Bronsert; Anne Lambert-Kerzner; William G Henderson; Howe Qiu; Kathryn L Colborn; Nicholas J Mason; Robert A Meguid Journal: Patient Saf Surg Date: 2022-03-17