Key result
Low preoperative PROMIS-PF scores are linked to ~3.1-fold higher odds of major postoperative complications.
Why the study?
Preoperative risk assessment is resource-intensive, motivating evaluation of whether patient-completed PROMIS-PF scores could serve as a low-resource tool to identify high-risk patients before noncardiac surgery.
Does preoperative PROMIS-PF score predict 30-day mortality and major complications in adults undergoing noncardiac surgery?
Cohort (n=3,399)
No
Does preoperative PROMIS-PF score predict 30-day mortality and major complications in adults undergoing noncardiac surgery?
Although lower preoperative PROMIS-PF scores are associated with higher odds of 30-day mortality and major complications in noncardiac surgery, the score alone has poor discriminative ability and does not improve upon a parsimonious clinical risk model.
Answers are grounded in this paper and cite their sources.
Low PROMIS-PF scores were associated with higher 30-day adverse odds; hypothesis-generating and should not yet alter perioperative risk assessment.
Background: Preoperative risk assessment is central to achieving optimal surgical outcomes but is resource-intensive. We hypothesized that Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) scores could serve as a low-resource, patient-completed tool to help identify high-risk surgical patients before surgery. Methods: We conducted a retrospective study of adults undergoing noncardiac surgery at a large academic medical center between 2015 and 2023. Multivariable logistic regression was used to examine the association between PROMIS-PF scores and the composite outcome of 30-day mortality and major complications. We evaluated the predictive performance of the PROMIS-PF score alone and compared it with a baseline clinical model, the baseline model plus PROMIS-PF score, and the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) risk calculator using optimism-corrected measures of discrimination and calibration. Results: Among 3,399 patients (mean ± SD of age: 57.3 ± 16.1 years; 1,719 [50.6%] were women and 1,680 [49.4%] were men), 152 (4.5%) had death or major complication; 12 died (0.35%); 687 (20.2%) had PROMIS-PF scores of 15 to 30; 2,498 (73.5%) had scores of 31 to 55; and 214 (6.3%) had scores of 56 to 80. Compared with PROMIS-PF scores of 56 to 80, those with scores of 15 to 30 had significantly higher odds of adverse outcomes (adjusted odds ratio [aOR], 3.13; 95% CI: 1.24 to 7.94; P = 0.02), whereas those with scores of 31 to 55 did not differ significantly (aOR, 1.92; 95% CI: 0.84 to 4.38; P = 0.11). The PROMIS-PF score alone demonstrated poor discrimination (C statistic, 0.52) and poor calibration (calibration slope, 0.64; calibration intercept, −1.1). The parsimonious clinical model (without PROMIS-PF score) showed very good discrimination (C statistic, 0.82) and acceptable calibration (calibration slope, 0.93; calibration intercept, −0.19); the addition of PROMIS-PF score to the clinical model did not improve the performance of the clinical model. The ACS NSQIP risk calculator exhibited worse discrimination (C statistic, 0.78) but better calibration (calibration slope: 0.99; calibration intercept: −0.03) than the baseline clinical model. In our secondary analysis, we found that a PROMIS-PF score of 30 or lesser was strongly associated with the ACS-NSQIP risk of 30-day mortality. Compared with patients with a predicted risk of mortality of 0.1% or lesser, patients with a predicted mortality of 5.0 to 10.0% (aOR, 20.6; 95% CI: 7.20 to 58.7; P < 0.001) and greater than 10.0% (aOR, 66.9; 95% CI: 26.8 to 167.1; P < 0.001) had higher odds of PROMIS-PF score of 30 or lesser. Conclusion: In this single-center exploratory study, lower preoperative PROMIS-PF scores were associated with higher 30-day mortality and major complications among patients undergoing noncardiac surgery. Although the PROMIS-PF score demonstrated limited predictive value for the composite outcome, it was strongly associated with the ACS NSQIP-predicted risk of 30-day mortality. Further evaluation of low PROMIS-PF scores as a predictor of 30-day mortality in a larger multicenter cohort is warranted.
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Lander et al. (2026) conducted a cohort in Adults undergoing noncardiac surgery (n=3,399). Preoperative PROMIS-PF score of 15 to 30 vs. Preoperative PROMIS-PF score of 56 to 80 was evaluated on Composite of 30-day mortality and major complications (aOR 3.13, 95% CI 1.24-7.94, p=0.02). Preoperative PROMIS-PF scores of 15-30 vs 56-80 were associated with higher odds of 30-day mortality or major complications (aOR 3.13; 95% CI 1.24-7.94; P=0.02).
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