Preoperative Use of POTTER: Not Magical, But Clinically Impactful

INTRODUCTION Emergency General Surgery (EGS) is a distinct surgical population 1 with a disproportionate burden of adverse outcomes and system-level costs relative to elective surgery.2, 3, 4, 5, 6, 7 While acuity of presentation is a major contributor to outcomes,4, 7, 8 EGS has been found to be an independent predictor of morbidity and mortality.2, 3 Patients commonly arrive with advanced disease, systemic inflammation or sepsis, acute physiologic derangements, and limited time for preoperative evaluation METHODS The study period spanned September 1, 2023 through August 31, 2025. Beginning September 1, 2024, the Predictive OpTimal Trees in Emergency Surgery Risk (POTTER) calculator was introduced on the EGS service for use in the preoperative setting to support surgical decision making and counseling. Implementation was communicated through EGS rounds and service meetings with ongoing reminders. Clinician-level POTTER use was not systematically documented for individual patients. As such, analyses RESULTS A total of 104 patients underwent colectomy by the EGS service during the study period, including 54 in the pre-implementation and 50 in the post-implementation cohort. Age, sex, race, and ethnicity did not differ significantly between cohorts (Table 1). The majority of patients were White followed by American Indian or Alaska Native, with Hispanic ethnicity predominating in both cohorts. Body mass index and ASA class were not significantly different. Major comorbidities were similar, including DISCUSSION In this single-center observational study of EGS colectomy patients, implementation of the POTTER calculator in the preoperative setting was not associated with a statistically significant reduction in the primary outcome of in-hospital mortality. There was also no difference detected in 30-day mortality. However, the post-implementation era was associated with a significant reduction in any postoperative complication, with rates decreasing from 57.4% to 34.0% (p = 0.017). Although in-hospital CONCLUSIONS POTTER implementation was not associated with a significant difference in in-hospital mortality among EGS patients undergoing colectomy. The post-implementation era was associated with fewer postoperative complications, a prespecified secondary outcome. Prospective multicenter studies are needed to further elucidate the impacts of POTTER implementation on outcomes.