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J Am Coll Surg. 2016 Nov;223(5):685-693. doi: 10.1016/j.jamcollsurg.2016.08.542. Epub 2016 Sep 22.

Development and Evaluation of the American College of Surgeons NSQIP Pediatric Surgical Risk Calculator.

Author information

1
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL. Electronic address: kkraemer@facs.org.
2
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL.
3
Division of Pediatric Surgery, Primary Children's Medical Center, University of Utah, Salt Lake City, UT.
4
Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
5
Department of Surgery, Washington University in St Louis, St Louis, MO.
6
Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Chicago, IL; Northwestern Medicine, Northwestern University, Chicago, IL.
7
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, University of California Los Angeles David Geffen School of Medicine and the VA Greater Los Angeles Healthcare System, Los Angeles, CA.
8
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL; Department of Surgery, Washington University in St Louis, St Louis, MO; Center for Health Policy and the Olin Business School at Washington University in St Louis; John Cochran Veterans Affairs Medical Center; and BJC Healthcare, St Louis, MO.

Abstract

BACKGROUND:

There is an increased desire among patients and families to be involved in the surgical decision-making process. A surgeon's ability to provide patients and families with patient-specific estimates of postoperative complications is critical for shared decision making and informed consent. Surgeons can also use patient-specific risk estimates to decide whether or not to operate and what options to offer patients. Our objective was to develop and evaluate a publicly available risk estimation tool that would cover many common pediatric surgical procedures across all specialties.

STUDY DESIGN:

American College of Surgeons NSQIP Pediatric standardized data from 67 hospitals were used to develop a risk estimation tool. Surgeons enter 18 preoperative variables (demographics, comorbidities, procedure) that are used in a logistic regression model to predict 9 postoperative outcomes. A surgeon adjustment score is also incorporated to adjust for any additional risk not accounted for in the 18 risk factors.

RESULTS:

A pediatric surgical risk calculator was developed based on 181,353 cases covering 382 CPT codes across all specialties. It had excellent discrimination for mortality (c-statistic = 0.98), morbidity (c-statistic = 0.81), and 7 additional complications (c-statistic > 0.77). The Hosmer-Lemeshow statistic and graphic representations also showed excellent calibration.

CONCLUSIONS:

The ACS NSQIP Pediatric Surgical Risk Calculator was developed using standardized and audited multi-institutional data from the ACS NSQIP Pediatric, and it provides empirically derived, patient-specific postoperative risks. It can be used as a tool in the shared decision-making process by providing clinicians, families, and patients with useful information for many of the most common operations performed on pediatric patients in the US.

[Indexed for MEDLINE]

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