Quantifying the Prognostic Value of Preoperative Surgeon Intuition: Comparing Surgeon Intuition and Clinical Risk Prediction as Derived from the American College of Surgeons NSQIP Risk Calculator.

Autor:	Marwaha JS; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat).; the Department of Biomedical Informatics, Harvard Medical School, Boston, MA (Marwaha, Beaulieu-Jones, Yuan, Brat)., Beaulieu-Jones BR; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat).; the Department of Biomedical Informatics, Harvard Medical School, Boston, MA (Marwaha, Beaulieu-Jones, Yuan, Brat)., Berrigan M; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat)., Yuan W; the Department of Biomedical Informatics, Harvard Medical School, Boston, MA (Marwaha, Beaulieu-Jones, Yuan, Brat)., Odom SR; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat)., Cook CH; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat)., Scott BB; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat)., Gupta A; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat)., Parsons CS; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat)., Seshadri AJ; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat)., Brat GA; From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat).; the Department of Biomedical Informatics, Harvard Medical School, Boston, MA (Marwaha, Beaulieu-Jones, Yuan, Brat).
Jazyk:	angličtina
Zdroj:	Journal of the American College of Surgeons [J Am Coll Surg] 2023 Jun 01; Vol. 236 (6), pp. 1093-1103. Date of Electronic Publication: 2023 Feb 23.
DOI:	10.1097/XCS.0000000000000658
Abstrakt:	Background: Surgical risk prediction models traditionally use patient attributes and measures of physiology to generate predictions about postoperative outcomes. However, the surgeon's assessment of the patient may be a valuable predictor, given the surgeon's ability to detect and incorporate factors that existing models cannot capture. We compare the predictive utility of surgeon intuition and a risk calculator derived from the American College of Surgeons (ACS) NSQIP. Study Design: From January 10, 2021 to January 9, 2022, surgeons were surveyed immediately before performing surgery to assess their perception of a patient's risk of developing any postoperative complication. Clinical data were abstracted from ACS NSQIP. Both sources of data were independently used to build models to predict the likelihood of a patient experiencing any 30-day postoperative complication as defined by ACS NSQIP. Results: Preoperative surgeon assessment was obtained for 216 patients. NSQIP data were available for 9,182 patients who underwent general surgery (January 1, 2017 to January 9, 2022). A binomial regression model trained on clinical data alone had an area under the receiver operating characteristic curve (AUC) of 0.83 (95% CI 0.80 to 0.85) in predicting any complication. A model trained on only preoperative surgeon intuition had an AUC of 0.70 (95% CI 0.63 to 0.78). A model trained on surgeon intuition and a subset of clinical predictors had an AUC of 0.83 (95% CI 0.77 to 0.89). Conclusions: Preoperative surgeon intuition alone is an independent predictor of patient outcomes; however, a risk calculator derived from ACS NSQIP is a more robust predictor of postoperative complication. Combining intuition and clinical data did not strengthen prediction. (Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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