1. riskcalculator.facs.org Mila H. Ju, MD Jennifer L. Paruch, MD August 15, 2013 SUSP webinar

2. riskcalculator.facs.org What is the need for risk calculator? Informed consent –Thorough understanding of potential complications with surgery Shared decision making process –Type of operation –Or if surgery should be performed at all

3. riskcalculator.facs.org What is the need for risk calculator? Information traditionally based on –Surgeon experience –Literature Single institution studies Clinical trials And not specific to individual patient characteristics

4. riskcalculator.facs.org

5. Development of the Risk Calculator ACS NSQIP Data (2009-2012) –30-day outcomes –Risk-adjusted using patient demographics, comorbidities and laboratory values –Collected by trained and audited surgical clinical reviewers (SCRs) –Standardized data definitions –Captures complications that occur after discharge or at another hospital –Superior to administrative data Lawson et al., Annals of Surgery, December 2012

6. riskcalculator.facs.org Development of the Risk Calculator 1,414,006 patients (393 hospitals) All surgical subspecialties (1,557 CPT codes) 21 pre-operative factors  10 outcomes Similar performance to previous, procedure-specific risk calculators for ACS NSQIP Includes new Surgeon Adjustment Score (SAS)

7. riskcalculator.facs.org Demonstration

13. Surgeon Adjustment Score Surgeons can adjust estimate using clinical judgment Risk factors not captured by the Risk Calculator 2ONE standard deviation above CPT mean 3 TWO standard deviations above CPT mean

14. riskcalculator.facs.org Surgeon Adjustment Score

15. riskcalculator.facs.org Surgeon Adjustment Score

16. riskcalculator.facs.org Surgeon Adjustment Score: Comments from NSQIP Meeting

17. riskcalculator.facs.org ? ?

18. Risk calculator uses patient characteristics. From 2012 SUSP presentation by Dr.Berenholtz and Dr.Goeschel: The Science of Safety Help target patients with high risks.

19. riskcalculator.facs.org Information from Risk Calculator will help patients get the evidence. From 2012 SUSP presentation by Dr.Berenholtz:

20. riskcalculator.facs.org Information from Risk Calculator will help reducing harm. From 2012 SUSP presentation by Goeschel, Hobson, Wick, & Lubomski: CUSP

21. riskcalculator.facs.org Useful tool –Informed consent / decision aid –Prevent / reduce complications Easily accessible –No log-in, no fee –Just internet connection

22. riskcalculator.facs.org In the future –Application for iPad, iPhone, and other smartphones –PDF, email, or print functions

23. riskcalculator.facs.org Mila H. Ju, MD Jennifer L. Paruch, MD riskcalculator.facs.org

24. Are you going to the Annual ACS Clinical Congress? (October 6-10, 2013) Join the SUSP National team for breakfast! When: Monday, October 7 @ 6:30am EST Where: Renaissance Hotel in DC (room 12 & 13) Why: Network with other surgeons participating in the SUSP project