Current use of the National Surgical Quality Improvement Program surgical risk calculator in academic surgery: a mixed-methods study

Authors

Samuel M. Miller, Department of Surgery, Yale School of Medicine, United States.
Sara Abou Azar, Department of Surgery, Yale School of Medicine, United States.
James S. Farrelly, Department of Surgery, Quinnipiac University School of Medicine, United States.
Garrett A. Salzman, Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, United States.
Meaghan E. Broderick, Department of Surgery, Stamford Health System, United States.
Katherine M. Sanders, Department of Surgery, UCSF School of Medicine, United States.
Vincent P. Anto, Department of Surgery, University of Pittsburgh School of Medicine, United States.
Nathan Patel, Department of Surgery, Wake Forest School of Medicine, United States.
Alfredo C. Cordova, Department of Surgery, The Ohio State University College of Medicine, United States.
Kevin M. Schuster, Department of Surgery, Yale School of Medicine, United States.Follow
Tyler J. Jones, Department of Surgery, Yale School of Medicine, United States.Follow
Lisa M. Kodadek, Department of Surgery, Yale School of Medicine, United States.Follow
Cary P. Gross, Department of Medicine, Yale School of Medicine, United States.
John M. Morton, Department of Surgery, Yale School of Medicine, United States.
Ronnie A. Rosenthal, Department of Surgery, Yale School of Medicine, United States.
Robert D. Becher, Department of Surgery, Yale School of Medicine, United States.Follow

Document Type

Article

Publication Title

Surgery in practice and science

Abstract

BACKGROUND: This study aims to quantitatively assess use of the NSQIP surgical risk calculator (NSRC) in contemporary surgical practice and to identify barriers to use and potential interventions that might increase use. MATERIALS AND METHODS: We performed a cross-sectional study of surgeons at seven institutions. The primary outcomes were self-reported application of the calculator in general clinical practice and specific clinical scenarios as well as reported barriers to use. RESULTS: In our sample of 99 surgeons (49.7% response rate), 73.7% reported use of the NSRC in the past month. Approximately half (51.9%) of respondents reported infrequent NSRC use (<20% of preoperative discussions), while 14.3% used it in ≥40% of preoperative assessments. Reported use was higher in nonelective cases (30.2% vs 11.1%) and in patients who were ≥65 years old (37.1% vs 13.0%), functionally dependent (41.2% vs 6.6%), or with surrogate consent (39.9% vs 20.4%). NSRC use was not associated with training status or years in practice. Respondents identified a lack of influence on the decision to pursue surgery as well as concerns regarding the calculator's accuracy as barriers to use. Surgeons suggested improving integration to workflow and better education as strategies to increase NSRC use. CONCLUSIONS: Many surgeons reported use of the NSRC, but few used it frequently. Surgeons reported more frequent use in nonelective cases and frail patients, suggesting the calculator is of greater utility for high-risk patients. Surgeons raised concerns about perceived accuracy and suggested additional education as well as integration of the calculator into the electronic health record.

DOI

10.1016/j.sipas.2023.100173

Publication Date

6-1-2023

Recommended Citation

Miller, Samuel M.; Azar, Sara Abou; Farrelly, James S.; Salzman, Garrett A.; Broderick, Meaghan E.; Sanders, Katherine M.; Anto, Vincent P.; Patel, Nathan; Cordova, Alfredo C.; Schuster, Kevin M.; Jones, Tyler J.; Kodadek, Lisa M.; Gross, Cary P.; Morton, John M.; Rosenthal, Ronnie A.; and Becher, Robert D., "Current use of the National Surgical Quality Improvement Program surgical risk calculator in academic surgery: a mixed-methods study" (2023). Surgery. 27.
https://scholar.bridgeporthospital.org/surgery/27

Identifier

37502700 (pubmed); NIHMS1906910 (mid); PMC10373440 (pmc); 10.1016/j.sipas.2023.100173 (doi); 100173 (pii)