Informed Consent Tool Aids Presurgical Assessment

A new universal surgical risk calculator aids shared decision-making and informed consent for both patients and surgeons.

Researchers at the American College of Surgeons (ACS; Chicago, IL, USA) used standardized clinical data from 393 hospitals affiliated with the ACS Surgical Quality Improvement Program (NSQIP) to develop a web-based tool to allow surgeons to enter 21 preoperative factors, such as demographics, comorbidities, and procedure, and predict risk outcomes based on these factors; a universal model was compared to procedure-specific models, such as colorectal. To incorporate surgeon input, a subjective Surgeon Adjustment Score (SAS) allowing risk estimates to vary within a confidence interval was introduced and tested among 80 surgeons using 10 case scenarios.


The result, based on 1,414,006 patients encompassing 1,557 unique current procedural terminology (CPT) codes, is a universal surgical risk calculator model with excellent performance for mortality, morbidity, and six additional complications. Predictions were similarly robust for the universal calculator as for the procedure-specific calculators. SAS scores showed that surgeons demonstrated considerable agreement on the case scenario scoring, suggesting reliable score assignment between surgeons. The study describing the surgical risk calculator was published on July 17, 2013, in the Journal of the American College of Surgeons.

“The ACS NSQIP Surgical Risk Calculator is a decision-support tool based on reliable multi-institutional clinical data which can be used to estimate the risks of most operations,” concluded lead author Karl Bilimoria, MD, and colleagues of the ACS. “It will allow clinicians and patients to make decisions using empirically derived, patient-specific postoperative risks.”

According to the researchers, The US Centers for Medicare and Medicaid Services (CMS; Baltimore, MD, USA) may soon put forth a measure requiring US surgeons to provide patients with patient-specific, empirically derived estimates of postoperative complications.

Related Links:
American College of Surgeons
US Centers for Medicare and Medicaid Services
ACS NSQIP Surgical Risk Calculator webpage