Key result
Being 85 years or older strongly predicted discharge to postacute care after surgery (OR 9.17; 95% CI 8.84-9.50), and the final risk prediction model demonstrated excellent accuracy.
Cohort (n=973,211)
Yes
Odds Ratio: 9.17 (95% CI 8.84–9.5)
A risk prediction model using ACS NSQIP data can accurately predict the risk of discharge to postacute care for surgical patients.
May inform preoperative planning for patients ≥85 years; extends NSQIP prediction but leaves open prospective validation.
IMPORTANCE: Individualized risk prediction tools have an important role as decision aids for use by patients and surgeons before surgery. Patient-centered outcomes should be incorporated into such tools to widen their appeal and improve their usability. OBJECTIVE: To develop a patient-centered outcome for the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator, a web-based, individualized risk prediction tool. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using data from the ACS NSQIP, a national clinical data registry. A total of 973 211 patients from July 2010 to June 2012, encompassing 392 hospitals, were used in this analysis. MAIN OUTCOMES AND MEASURES: Risk of discharge to a postacute care setting. RESULTS: The overall rate of discharge to postacute care was 8.8%. Significant predictors of discharge to postacute care included being 85 years or older (odds ratio [OR] = 9.17; 95% CI, 8.84-9.50), the presence of septic shock (OR = 2.43; 95% CI, 2.20-2.69) or ventilator dependence (OR = 2.81; 95% CI, 2.56-3.09) preoperatively, American Society of Anesthesiologists class of 4 or 5 (OR = 3.59; 95% CI, 3.46-3.71), and totally dependent functional status (OR = 2.27; 95% CI, 2.11-2.44). The final model predicted risk of discharge to postacute care with excellent accuracy (C statistic = 0.924) and calibration (Brier score = 0.05). CONCLUSIONS AND RELEVANCE: Individualized risk of discharge to postacute care can be predicted with excellent accuracy. This outcome will be incorporated into the ACS NSQIP Surgical Risk Calculator.
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Mohanty et al. (2015) conducted a cohort in Surgical patients (n=973,211). Age ≥85 years vs. Age <85 years was evaluated on Discharge to a postacute care setting (OR 9.17, 95% CI 8.84-9.50). Being 85 years or older strongly predicted discharge to postacute care after surgery (OR 9.17; 95% CI 8.84-9.50), and the final risk prediction model demonstrated excellent accuracy.
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