Abstract
Purpose
The study investigates whether postoperative complications in elective surgery can be reduced by using a risk calculator via raising the awareness of the surgeon in a preoperative briefing. Postoperative complications like wound infections or pneumonia result in a high burden for healthcare systems. Multiple quality improvement programs address this problem like the ACS NSQIP Surgical Risk Calculator® (SRC).
Methods
To determine whether the preoperative usage of the SRC could reduce inpatient postoperative complications, two groups of 832 patients each were compared using propensity score matching. The SRC was employed retrospectively in the period 2012/2013 in one group (“Retro”) and prospectively in the other group (“Prosp”) in the period 2014/2015. Actual inpatient postoperative complications were classified by SRC complication categories and compared with the Clavien–Dindo complication classification system (Dindo et al. in Ann Surg 240:205–213, 2004).
Results
Comparing SRC “serious complication” and SRC “any complication,” a nonsignificant increase in the “Prosp”-group was apparent (serious complication: 6.6% vs. 8.5%, p = 0.164; any complication: 8.5% vs. 9.7%, p = 0.444).
Conclusion
Use of the SRC neither reduces inpatient postoperative complications nor the severity of complications. The calculations of the SRC rely on a 30-day postoperative follow-up. Poor sensitivity and medium specificity of the SRC showed that the SRC could not make accurate predictions in a short follow-up time averaging 6 days. Alternatively, since the observed complication rate was low in our study, in an environment of already highly implemented risk management tools, reductions in complications are not easily achieved.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. www.thelancet.com. 372:139
Weiser TG, Haynes AB, Molina G et al (2016) Size and distribution of the global volume of surgery in 2012. Bull World Health Organ 94:201–209F
Pearse RM, Clavien PA, Demartines N et al (2016) Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth 117:601–609
Haugen AS, Søfteland E, Almeland SK et al (2015) Effect of the World Health Organization checklist on patient outcomes: a stepped wedge cluster randomized controlled trial. Ann Surg 261:821–828
Treadwell JR, Lucas S, Tsou AY (2014) Surgical checklists: a systematic review of impacts and implementation. BMJ Qual Saf 23:299–318
Howell AM, Panesar SS, Burns EM et al (2014) Reducing the burden of surgical harm: a systematic review of the interventions used to reduce adverse events in surgery. Ann Surg 259:630–641
Neily J, Mills PD, Young-Xu Y et al (2010) Association between implementation of a medical team training program and surgical mortality. JAMA 304:1693
Nundy S, Mukherjee A, Sexton JB et al (2008) Impact of preoperative briefings on operating room delays. Arch Surg 143:1068
Salas E, Frush K (2012) Improving patient safety through teamwork and team training. In: Improving patient safety through teamwork and team training, 1st ed. Oxford University Press, Oxford, p 170
Sacks GD, Dawes AJ, Ettner SL et al (2016) Surgeon perception of risk and benefit in the decision to operate. Ann Surg 264:896–903
Bilimoria KY, Liu Y, Paruch JL et al (2013) Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg 217:833–842.e3
Vogel P, Vogel DHV (2019) Cognition errors in the treatment course of patients with anastomotic failure after colorectal resection. BMC 6:1–10
Hull L, Arora S, Aggarwal R et al (2012) The impact of nontechnical skills on technical performance in surgery: a systematic review. J Am Coll Surg 214:214–230
Ogrinc G, Davies L, Goodman D et al (2016) SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process Table 1 Revised Standards for QUality Improvement Reporting Excellence (SQUIRE 2.0) publication guidelines. J Contin Educ Nursing, J Am Coll Surg 25:986–992
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Vanhaecht K, Ovretveit J, Elliott MJ et al (2012) Have we drawn the wrong conclusions about the value of care pathways? Is a cochrane review appropriate? Eval. Heal. Prof. 35:28–42
Tevis S (2014) Implications of multiple complications on post-operative recovery in general surgery patients. J Am Coll Surg 219:e36
Schneider EC, Sarnak DO, Squires D et al (2017) Mirror, Mirror 2017: international comparison reflects flaws and opportunities for better U.S. Health Care
Sacks GD, Dawes AJ, Ettner SL et al (2016) Impact of a risk calculator on risk perception and surgical decision making: a randomized trial. Ann Surg 264:889–895
Glasgow RE, Hawn MT, Hosokawa PW et al (2014) Comparison of prospective risk estimates for postoperative complications: human versus computer model. J Am Coll Surg 218:237–245
Markus PM, Martell J, Leister I et al (2005) Predicting postoperative morbidity by clinical assessment. Br J Surg 92:101–106
Thompson JS, Baxter BT, Allison JG et al (2003) Temporal patterns of postoperative complications. Arch Surg 138:596–603
Lonjon G, Porcher R, Ergina P et al (2017) Potential pitfalls of reporting and bias in observational studies with propensity score analysis assessing a surgical procedure. Ann Surg 265:901–909
Lonjon G, Boutron I, Trinquart L et al (2014) Comparison of treatment effect estimates from prospective nonrandomized studies with propensity score analysis and randomized controlled trials of surgical procedures. Ann Surg 259:18–25
Weigel TF, Hanisch E, Hanisch A et al (2019) Power of judgment: the significance of Kant’s philosophy for the medical system today. J Surg Educ 76:4–8
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Müller, E.M., Herrmann, E., Schmandra, T. et al. Report of a Quality Improvement Program for Reducing Postoperative Complications by Using a Surgical Risk Calculator in a Cohort of General Surgery Patients. World J Surg 44, 1745–1754 (2020). https://doi.org/10.1007/s00268-020-05393-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-020-05393-6