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The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Has a Role in Predicting Discharge to Post-Acute Care in Total Joint Arthroplasty.
J Arthroplasty. 2018 01; 33(1):25-29.JA

Abstract

BACKGROUND

Patient demand and increasing cost awareness have led to the creation of surgical risk calculators that attempt to predict the likelihood of adverse events and to facilitate risk mitigation. The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator is an online tool available for a wide variety of surgical procedures, and has not yet been fully evaluated in total joint arthroplasty.

METHODS

A single-center, retrospective review was performed on 909 patients receiving a unilateral primary total knee (496) or hip (413) arthroplasty between January 2012 and December 2014. Patient characteristics were entered into the risk calculator, and predicted outcomes were compared with observed results. Discrimination was evaluated using the receiver-operator area under the curve (AUC) for 90-day readmission, return to operating room (OR), discharge to skilled nursing facility (SNF)/rehab, deep venous thrombosis (DVT), and periprosthetic joint infection (PJI).

RESULTS

The risk calculator demonstrated adequate performance in predicting discharge to SNF/rehab (AUC 0.72). Discrimination was relatively limited for DVT (AUC 0.70, P = .2), 90-day readmission (AUC 0.63), PJI (AUC 0.67), and return to OR (AUC 0.59). Risk score differences between those who did and did not experience discharge to SNF/rehab, 90-day readmission, and PJI reached significance (P < .01). Predicted length of stay performed adequately, only overestimating by 0.2 days on average (rho = 0.25, P < .001).

CONCLUSION

The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator has fair utility in predicting discharge to SNF/rehab, but limited usefulness for 90-day readmission, return to OR, DVT, and PJI. Although length of stay predictions are similar to actual outcomes, statistical correlation remains relatively weak.

Authors+Show Affiliations

Duke University School of Medicine, Duke University Medical Center Greenspace, Durham, North Carolina.Duke University School of Medicine, Duke University Medical Center Greenspace, Durham, North Carolina.Duke University School of Medicine, Duke University Medical Center Greenspace, Durham, North Carolina.Duke University School of Medicine, Duke University Medical Center Greenspace, Durham, North Carolina.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28899592

Citation

Goltz, Daniel E., et al. "The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Has a Role in Predicting Discharge to Post-Acute Care in Total Joint Arthroplasty." The Journal of Arthroplasty, vol. 33, no. 1, 2018, pp. 25-29.
Goltz DE, Baumgartner BT, Politzer CS, et al. The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Has a Role in Predicting Discharge to Post-Acute Care in Total Joint Arthroplasty. J Arthroplasty. 2018;33(1):25-29.
Goltz, D. E., Baumgartner, B. T., Politzer, C. S., DiLallo, M., Bolognesi, M. P., & Seyler, T. M. (2018). The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Has a Role in Predicting Discharge to Post-Acute Care in Total Joint Arthroplasty. The Journal of Arthroplasty, 33(1), 25-29. https://doi.org/10.1016/j.arth.2017.08.008
Goltz DE, et al. The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Has a Role in Predicting Discharge to Post-Acute Care in Total Joint Arthroplasty. J Arthroplasty. 2018;33(1):25-29. PubMed PMID: 28899592.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator Has a Role in Predicting Discharge to Post-Acute Care in Total Joint Arthroplasty. AU - Goltz,Daniel E, AU - Baumgartner,Billy T, AU - Politzer,Cary S, AU - DiLallo,Marcus, AU - Bolognesi,Michael P, AU - Seyler,Thorsten M, Y1 - 2017/08/18/ PY - 2017/06/21/received PY - 2017/07/31/revised PY - 2017/08/09/accepted PY - 2017/9/14/pubmed PY - 2018/6/9/medline PY - 2017/9/14/entrez KW - ACS-NSQIP KW - complications KW - primary hip arthroplasty KW - primary knee arthroplasty KW - risk calculator SP - 25 EP - 29 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 33 IS - 1 N2 - BACKGROUND: Patient demand and increasing cost awareness have led to the creation of surgical risk calculators that attempt to predict the likelihood of adverse events and to facilitate risk mitigation. The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator is an online tool available for a wide variety of surgical procedures, and has not yet been fully evaluated in total joint arthroplasty. METHODS: A single-center, retrospective review was performed on 909 patients receiving a unilateral primary total knee (496) or hip (413) arthroplasty between January 2012 and December 2014. Patient characteristics were entered into the risk calculator, and predicted outcomes were compared with observed results. Discrimination was evaluated using the receiver-operator area under the curve (AUC) for 90-day readmission, return to operating room (OR), discharge to skilled nursing facility (SNF)/rehab, deep venous thrombosis (DVT), and periprosthetic joint infection (PJI). RESULTS: The risk calculator demonstrated adequate performance in predicting discharge to SNF/rehab (AUC 0.72). Discrimination was relatively limited for DVT (AUC 0.70, P = .2), 90-day readmission (AUC 0.63), PJI (AUC 0.67), and return to OR (AUC 0.59). Risk score differences between those who did and did not experience discharge to SNF/rehab, 90-day readmission, and PJI reached significance (P < .01). Predicted length of stay performed adequately, only overestimating by 0.2 days on average (rho = 0.25, P < .001). CONCLUSION: The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator has fair utility in predicting discharge to SNF/rehab, but limited usefulness for 90-day readmission, return to OR, DVT, and PJI. Although length of stay predictions are similar to actual outcomes, statistical correlation remains relatively weak. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/28899592/The_American_College_of_Surgeons_National_Surgical_Quality_Improvement_Program_Surgical_Risk_Calculator_Has_a_Role_in_Predicting_Discharge_to_Post_Acute_Care_in_Total_Joint_Arthroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(17)30697-6 DB - PRIME DP - Unbound Medicine ER -