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Utilizing the ACS NSQIP risk calculator as an inform consent tool for patients undergoing surgery
When a patient is planning to undergo an operation, it is important that she/he has full understanding of what the proposed surgical intervention is along with the risk of surgery. This is especially critical if the patient has a lot of comorbidities that may put him or her at higher risks of postoperative complications.
More importantly, clinicians and patients need information regarding surgical risks in order to make decisions on the type of operation or whether surgery should be performed at all. It is critical that the patient has a thorough understanding of the potential risks associated with the surgery as this is part of informed consent.
The ACS NSQIP (American College of Surgeons National Surgical Quality Improvement Program) risk calculator is a tool that helps clinicians estimate a patient’s surgical risks. The risk calculator utilizes clinical data from 393 ACS NSQIP hospitals with the following subspecialties: general surgery, gynecology, neurosurgery, orthopedics, ENT, plastic surgery, cardiothoracic surgery, urology, and vascular surgery. From those hospitals, approximately 1.4 million patients were identified and utilized in the development of the risk calculator. Of all the cases, 99% were within the CPT codes. In total, there are approximately 2557 unique CPT codes available in the ACS surgical risk calculator. The calculator included 21 predictor variables and reported on eight 30-day postoperative outcomes. Additionally, surgeons are able to adjust the risks if they deem it to be necessary if the risk was not reflected already in the patient information.
Prior to the development of the NSQIP risk calculator, prediction on postoperative risks and identifying those who are at higher risk of adverse events have been based on the surgeon’s experience in addition to published data. However, they were not estimates based on the patient’s comorbidities, hence their specific risk factors (presence of renal failure, heart failure, BMI, level of independence, etc.).
To utilize the NSQIP risk calculator:
- Check that you are not robot and the disclaimer.
- On the second page (refer to Figure 1), you will be able to enter the proposed procedure. Select the one closest to it. However, given that there are approximately 2600 CPT codes, it is not likely that you will run into difficulty locating the proposed surgery.
- Enter all the required information on your patient as accurately as possible in order to provide the best estimate.
- When you are done, select continue.
- Figure 2 provides the personalized estimate of the outcome. It provides a graphical depiction of the average risk and your patient’s risk, plus the average length of stay.
- Additionally, the surgeon is able to make adjustment on the patient’s risk based on his or her clinical experience that was not reflected into the patient’s information.
- You are also able to go back and change risk factors, if you have entered something incorrectly. It will take you back to the previous page.
- Hit continue and you will receive a new estimate.
- Lastly, you have the option to print and/or email the report to share with your patient.
Figure 1: Patient information and proposed surgical intervention
Figure 2: Estimated risk based on the entered information
In summary, risk assessment tools are already being utilized in other disciplines (STS risk calculator, ARISCAT Score for pulmonary complications). The ACS NSQIP risk calculator offers surgeons the tool to discuss with patients their individualize postoperative risks in a patient friendly format. As APPS, it is important that we have an understanding of this tool so that we can help patients comprehend their individualize risks and counsel them appropriately. It is also a tool to identify preoperative management strategies that may optimize a patient’s health status should they choose to undergo surgical intervention.
References:
Bilimora, KY et al. (2013). Development and evaluation of the Universal ACS NSQIP Surgical Risk Calculator: a decision aid and informed consent tool for patients and surgeons. J AM Coll Surg, 13, 833-842.
About NSQIP. (2019). American College of Surgeons. Retrieved from https://www.facs.org/quality-programs/acs-nsqip/about
