Surgery is such a complex field with immense variability in every patient. The ACS NSQIP risk calculator is an incredibly useful resource to help understand the surgical risk
https://riskcalculator.facs.org is an exceptional resource to provide reasonably accurate and patient specific risk information to help guide your perioperative decision making.
This calculator uses a series of 20 questions and the surgical procedure to provide 18 different outcomes within 30 days of the procedure. These include risk of death, serious complications and even the chance of whether the patient will need postoperative rehab.
Before this calculator existed I felt that I had a lack of insight into the risks outside of the intra-operative anaesthesia risk. As anaesthetists, we rarely follow up our patients and may not be aware of the patient’s risk a month after the operation. Even our surgical colleagues may not have great data on their patient’s risk profile on such a large scale.
This calculator was built using data from over ‘4.3 million operations in over 730 participating hospitals from 2013-2017‘
I find the calculator most useful when I have a particularly unwell patient. I am able to quickly plug in the requested data points and then assess the risk. Have a look at the risk profile below for this imaginary elderly male undergoing a laparoscopic cholecystectomy.
I find this incredibly useful information to guide my perioperative management and providing informed consent to the patient.
For example I may
- refer to HDU/ICU preop
- discuss risk factor modification and use it as a ‘teachable moment’
- use the data to highlight how high risk (or low risk) something might be to a patient or colleague who has a different opinion on the risk level
- plan post op nursing or rehab requirements
- choose to recommend a particular operation in a centre with ICU/cardiology support
- discuss the risks and benefits with more evidence than limited by my own experience
any questions please comment below!