Key result
The SURPAS universal risk models had lower accuracy for predicting 30-day outcomes in total joint arthroplasty compared to the original development cohort, with a mortality C-index of 0.82 vs 0.94.
Why the study?
The Surgical Risk Preoperative Assessment System (SURPAS) universal risk calculators had demonstrated excellent overall and specialty-specific performance, but had not been tested in patients undergoing lower-extremity total joint arthroplasty.
How accurate are the SURPAS universal risk calculators for predicting 30-day postoperative outcomes in patients undergoing total joint arthroplasty?
Population
Patients undergoing non-emergency THA or TKA from the 2012 ACS-NSQIP dataset
Comparison
Predicted outcome probabilities from SURPAS models vs observed 30-day postoperative outcomes
Design
Retrospective cohort validation study
Follow-up
30 days
Authors
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SURPAS shows limited accuracy in joint arthroplasty; leaves open universal calculator utility and supports procedure-specific model development.
Observational (n=36,792)
Yes
How accurate are the SURPAS universal risk calculators for predicting 30-day postoperative outcomes in patients undergoing total joint arthroplasty?
Effect estimate: C-index 0.82 (95% CI 0.76-0.88)
Absolute Event Rate: 0.82% vs 0.94%
Universal surgical risk calculators like SURPAS have lower accuracy and poor calibration for specific procedures like total joint arthroplasty, highlighting the need for procedure-specific risk models.
Trickey et al. (2020) conducted an observational in Total Joint Arthroplasty (TJA) (n=36,792). SURPAS universal risk calculators vs. Original SURPAS development dataset was evaluated on Discrimination (C-index) of SURPAS model for 30-day postoperative mortality (C-index 0.82, 95% CI 0.76-0.88). The SURPAS universal risk models had lower accuracy for predicting 30-day outcomes in total joint arthroplasty compared to the original development cohort, with a mortality C-index of 0.82 vs 0.94.
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