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Accurate Preoperative Prediction of Discharge Destination Using 8 Predictor Variables: A NSQIP Analysis.
Singh, Abhinav B; Bronsert, Michael R; Henderson, William G; Lambert-Kerzner, Anne; Hammermeister, Karl E; Meguid, Robert A.
Afiliação
  • Singh AB; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO.
  • Bronsert MR; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO.
  • Henderson WG; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO; Department of Biostatistics and Informati
  • Lambert-Kerzner A; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO.
  • Hammermeister KE; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO; Division of Cardiology, Department of Med
  • Meguid RA; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado School of Medicine, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO. Electronic address: robert.meguid@cuansch
J Am Coll Surg ; 230(1): 64-75.e2, 2020 01.
Article em En | MEDLINE | ID: mdl-31672678
BACKGROUND: With inpatient length of stay decreasing, discharge destination after surgery can serve as an important metric for quality of care. Additionally, patients desire information on possible discharge destination. Adequate planning requires a multidisciplinary approach, can reduce healthcare costs and ensure patient needs are met. The Surgical Risk Preoperative Assessment System (SURPAS) is a parsimonious risk assessment tool using 8 predictor variables developed from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) dataset. SURPAS is applicable to more than 3,000 operations in adults in 9 surgical specialties, predicts important adverse outcomes, and is incorporated into our electronic health record. We sought to determine whether SURPAS can accurately predict discharge destination. STUDY DESIGN: A "full model" for risk of postoperative "discharge not to home" was developed from 28 nonlaboratory preoperative variables from ACS NSQIP 2012-2017 dataset using logistic regression. This was compared with the 8-variable SURPAS model using the C index as a measure of discrimination, the Hosmer-Lemeshow observed-to-expected plots testing calibration, and the Brier score, a combined metric of discrimination and calibration. RESULTS: Of 5,303,519 patients, 447,153 (8.67%) experienced a discharge not to home. The SURPAS model's C index, 0.914, was 99.24% of that of the full model's (0.921); the Hosmer-Lemeshow plots indicated good calibration and the Brier score was 0.0537 and 0.0514 for the SUPAS and full model, respectively. CONCLUSIONS: The 8-variable SURPAS model preoperatively predicts risk of postoperative discharge to a destination other than home as accurately as the 28 nonlaboratory variable ACS NSQIP full model. Therefore, discharge destination can be integrated into the existing SURPAS tool, providing accurate outcomes to guide decision-making and help prepare patients for their postoperative recovery.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Alta do Paciente / Procedimentos Cirúrgicos Operatórios / Modelos Estatísticos / Transferência de Pacientes Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Surg Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Alta do Paciente / Procedimentos Cirúrgicos Operatórios / Modelos Estatísticos / Transferência de Pacientes Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Surg Assunto da revista: GINECOLOGIA / OBSTETRICIA Ano de publicação: 2020 Tipo de documento: Article País de publicação: Estados Unidos