Patient Safety in Surgery最新文献

{"title":"Improving the quality of surgical morbidity and mortality conference using a standardized reporting and assessment tool: a validation study from a large academic medical center in the United States.","authors":"Sarah M Dermody, Marc C Thorne, Robert J Morrison","doi":"10.1186/s13037-025-00433-3","DOIUrl":"10.1186/s13037-025-00433-3","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study is two-fold: (1) Improve the quality of Morbidity and Mortality conferences by developing a standardized presentation template and assessment tool; (2) Assess the intervention impact by comparing pre- and post-intervention data.</p><p><strong>Methods: </strong>A pre-post study was conducted at a tertiary care academic medical center between January 2022- January 2023. A standardized presentation template was created and a short assessment tool was developed to evaluate the quality of presentations on eight domains. We hypothesized that development of this template would significantly improve the quality of M&M conferences. Pre- and post-intervention data were compared using the Kruskal-Wallis test to evaluate for significant differences. Effect sizes for each domain were assessed by Cohen's d.</p><p><strong>Results: </strong>A total of 127 pre-intervention responses and 61 post-intervention responses were received over a six-month period. Statistically significant increases in post-intervention scores were noted in nearly all presentation domains, including clarity of case selection rationale, nature of the safety event, circumstances leading to the safety event, contributing factors, understanding of the safety event, and anticipated benefits to patient outcomes (p < 0.05). The effect sizes ranged from medium for rationale for case selection to small for the identification of corrective actions.</p><p><strong>Conclusions: </strong>The introduction of a standardized, guided template improved the quality of Morbidity and Mortality presentations, with medium effect sizes and statistically significant increases in nearly all surveyed domains. A ceiling effect in the overall assessment score was noted as presentations prior to the intervention were rated highly. Standardization of case selection and presentations can promote alignment of the Quality Improvement Morbidity and Mortality workflow with broader-scope initiatives, departmentally and institutionally.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"10"},"PeriodicalIF":2.6,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative infection, wrong-site surgery, and patient death after elective low-value orthopedic surgery: the epitome of preventable surgical complications.","authors":"Philip F Stahel, Navid Ziran","doi":"10.1186/s13037-025-00429-z","DOIUrl":"10.1186/s13037-025-00429-z","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"9"},"PeriodicalIF":2.6,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11931739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nocturnal elective coronary artery bypass grafting (CABG) surgery is not associated with increased one-year mortality.","authors":"Andreas Koköfer, Christian Dinges, Crispiana Cozowicz, Bernhard Wernly, Niklas Rodemund","doi":"10.1186/s13037-025-00430-6","DOIUrl":"10.1186/s13037-025-00430-6","url":null,"abstract":"<p><strong>Background: </strong>Elective coronary artery bypass grafting (CABG) surgeries are increasingly scheduled during nighttime or after-hours. This poses unique challenges, such as reduced staffing, disrupted circadian rhythms, and increased fatigue, which may potentially affect outcomes. Despite growing evidence on the impact of daytime on cardiac surgery outcome, results remain inconclusive. The current study aims to investigate a potential association between surgery timing (daytime: 7:00 AM to 7:00 PM vs. nighttime: 7:00 PM to 7:00 AM) and long-term survival in patients undergoing elective CABG.</p><p><strong>Methods: </strong>In this retrospective single-institution cohort study at the University Clinic Salzburg, Austria, we analyzed elective CABG surgeries performed between January 1, 2017, and December 31, 2021. The primary hypothesis was that nighttime elective CABG surgeries have worse long-term survival. Among 2,179 cardiac surgical procedures, 723 elective CABG surgeries were identified and analyzed. Long-term survival was assessed using Cox proportional hazard modeling, while secondary outcomes, including 30-day and one-year mortality rates, were evaluated through multiple linear regression analysis.</p><p><strong>Results: </strong>The one-year mortality rate was 2.6% (n = 19) for the observation period. Of the 723 patients, 646 (89.35%) underwent daytime surgery, and 77 (10.65%) had nighttime surgery. The median EuroScore II was 1.50 [1.00, 2.60] for daytime surgeries and 1.70 [1.10, 3.10] for nighttime surgeries (p = 0.111). There was no association between nighttime surgery and long-term mortality (aHR: 1.624, 95% CI: 0.589 to 3.662, p = 0.3179). Multivariable logistic regression analysis confirmed that nighttime surgeries were not significantly associated with increased one-year mortality (aOR: 1.089, 95% CI: 0.208 to 3.711, p = 0.905). No deaths occurred within 30 days in either group.</p><p><strong>Conclusion: </strong>This analysis found no significant association between nocturnal elective CABG operations and increased long-term or one-year mortality. This study did not aim to evaluate the economics of nocturnal surgeries at the investigated institution. To confirm our results that there is no increased morbidity and mortality associated with nocturnal CABG operations, and to understand the economic impact of nocturnal surgeries, prospective randomized studies would be necessary.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"8"},"PeriodicalIF":2.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the quality of surgical care through improved patient handover processes.","authors":"Jessica M Ryan, Deborah A McNamara","doi":"10.1186/s13037-025-00428-0","DOIUrl":"10.1186/s13037-025-00428-0","url":null,"abstract":"<p><p>Surgical handover remains a high-risk process with no gold standard for practice despite 20 years of available guidance. Variability in practice is common, and poorly performed handover poses significant, yet avoidable, risk to patients. Research in this domain is underfunded with widely heterogenous methodology, meaning that the evidence base for better handover is deficient. In this correspondence, recommendations are made to address these shortcomings, including standardised operating procedures supported by electronic health records to enable staff training and audit. Prioritisation of the sickest patients at the handover outset and two-way, verbal communication, including a \"read-back\" to confirm that information is both transmitted and received. Rigorous evaluation of handover interventions before use, and discontinuation of practices that add no value. Lastly, a core outcome set for surgical handover is urgently needed to improve the comparability of studies. By clearly defining best practices and demonstrating the impact of interventions on patient outcomes, surgeons will be more inclined to adopt meaningful improvements in handover processes.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"7"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909930/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of failure-to-rescue after coronary artery bypass grafting: a multicenter observational study from the REPLICCAR II registry in Brazil.","authors":"Gabrielle Barbosa Borgomoni, Roger Daglius Dias, Pedro Gabriel Melo de Barros E Silva, Marcelo Arruda Nakazone, Marco Antonio Praça de Oliveira, Valquíria Pelisser Campagnucci, Marcos Gradim Tiveron, Luís Augusto Ferreira Lisboa, Ludhmila Abrahão Hajjar, Jorge Passamani Zubelli, Fábio Biscegli Jatene, Omar Asdrúbal Vilca Mejia","doi":"10.1186/s13037-024-00417-9","DOIUrl":"10.1186/s13037-024-00417-9","url":null,"abstract":"<p><strong>Background: </strong>Failure-to-rescue refers to the rate of failure amongst healthcare teams in reversing complications that occur during a patient's hospitalization. This study aimed to investigate the failure-to-rescue rate following coronary artery bypass grafting (CABG).</p><p><strong>Methods: </strong>Cross-sectional cohort study of the multicenter database \"Registro Paulista de Cirurgia Cardiovascular II\" (REPLICCAR II), which includes data from nine reference centers for cardiac surgery in São Paulo State. The study population included patients > 18 years of age who had undergone primary and isolated CABG surgery between 2017 and 2019 in Brazil. The outcome measured was failure-to-rescue (including death and the development of postoperative complications: prolonged ventilation time, stroke, reoperation, and kidney injury). The study used the Society of Thoracic Surgeons (STS) risk score to calculate the expected complication rates.</p><p><strong>Results: </strong>Out of the 3964 patients, 439 developed one or more of the analyzed complications, and out of those, 94 died (2.37% of the full sample). The standardized mortality ratio (SMR) for patients who developed one complication was 8.84% (10.7%/1.21%), whereas those with two combinations of complications had an SMR of 32.34% (53.68%/1.66%) and three complications had an SMR of 42.02% (50%/1.19%). However, patients who progressed without the analyzed complications had an SMR of 0.95% (0.74%/0.80%).</p><p><strong>Conclusion: </strong>The REPLICCAR II database revealed a failure-to-rescue rate of 21.41% (94/439), and the SMR increased progressively according to the greater number of complications. Our findings emphasize the need to measure the impact of early diagnosis and effective hospital team response by parameterizing the risk of expected death after severe complications.</p><p><strong>Trial registration: </strong>The REPLICCAR Registry and The Statewide Quality Improvement Initiative, ID NCT05363696.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"6"},"PeriodicalIF":2.6,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11818038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical negligence compensation claims in knee meniscal surgery in Norway: a cross-sectional study.","authors":"Frank-David Øhrn, Asbjørn Årøen, Tommy Frøseth Aae","doi":"10.1186/s13037-025-00427-1","DOIUrl":"10.1186/s13037-025-00427-1","url":null,"abstract":"<p><strong>Background: </strong>Meniscal surgery is one of the most frequent orthopaedic procedures performed worldwide. There is a wide range of possible treatment errors that can occur following meniscal surgery. In Norway, patients subject to treatment errors by hospitals and private institutions can file a compensation claim free of charge to the Norwegian System of Patient Injury Compensation (NPE). The purpose of this study was to systematically analyse compensation claims filed to the NPE following meniscal surgery and evaluate gender effects on accepted claims. Our hypothesis was that there was no gender difference in accepted claims.</p><p><strong>Methods: </strong>We performed a cross-sectional study assessing all registered claims at the NPE after meniscal surgery from 2010 to 2020. The surgical procedures were stratified into subgroups following data collection. Data from the Norwegian Patient Registry were collected to obtain information on the numbers of the different procedures performed in hospitals and private institutions. We calculated frequencies and relative frequencies of categorical data. Differences in categorical data were calculated using the Pearson Chi-square test.</p><p><strong>Results: </strong>The total number of meniscal resections and sutures in the study period was 119,528. A total of 372 compensation claims were filed, 241 male and 130 female. Of these, 152 (40.9%) claims were accepted, while 220 (59.1%) were rejected. The most frequent reasons for filing a compensation claim were pain (114), followed by infection (98), wrong technique (38) and impaired function/instability (25).There was a significant gender difference in the acceptance of claims in favour of men (121 vs. 31, p < 0.001). A sensitivity analysis excluding infection as reason for compensation claim found no gender difference (p = 0.16) in acceptance of claims.</p><p><strong>Conclusion: </strong>Compensation claims after meniscal surgery are rare, with only 0.3% of patients filing a compensation claim. There was a marked preponderance of men with accepted claims due to a higher frequency of postoperative infections. Surgeons should be aware of this and take this into account in the decision-making before surgery.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"5"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11740367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of \"Enhanced Recovery After Surgery\" (ERAS) protocols vs. traditional perioperative care on patient outcomes after colorectal surgery: a systematic review.","authors":"Vaishnavi Kannan, Najeeb Ullah, Sunitha Geddada, Amir Ibrahiam, Zahraa Munaf Shakir Al-Qassab, Osman Ahmed, Iana Malasevskaia","doi":"10.1186/s13037-024-00425-9","DOIUrl":"10.1186/s13037-024-00425-9","url":null,"abstract":"<p><strong>Background: </strong>Colorectal surgery is associated with a high risk of postoperative complications, including technical complications, surgical site infections, and other adverse events affecting patient safety and overall patient experience. \"Enhanced Recovery After Surgery\" (ERAS) is considered a new standard of care for streamlining the perioperative care of surgical patients with the goal of minimizing complications and optimizing timely patient recovery after surgery. This systematic review was designed to investigate the evidence-based literature pertinent to comparing patient outcomes after ERAS versus conventional perioperative care.</p><p><strong>Methods: </strong>This systematic review evaluates the performance of ERAS protocols against conventional care in colorectal surgery, focusing on various postoperative outcome measures. An extensive search was conducted across multiple electronic databases and registers from July 2 to July 5, 2024, complemented by citation searching on November 30, 2024. This approach led to the identification of 11 randomized controlled trials (RCTs) from the past decade, involving 1,476 adult participants. To ensure methodological rigor and transparency, the review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines and was registered with PROSPERO (CRD42024583074).</p><p><strong>Results: </strong>The implementation of ERAS protocols resulted in a notable decrease in hospital stay duration compared to conventional care, with reductions varying between 3 and 8 days across studies. ERAS patients also had faster gastrointestinal recovery, including quicker times to bowel movement, defecation, and resumption of normal diet. Furthermore, patients in ERAS groups showed notably reduced postoperative complications and opioid consumption, with patients experiencing lower pain scores on the Visual Analogue Scale (VAS) and reduced reliance on opioids. Additionally, nutritional recovery in ERAS patients was enhanced, with elevated albumin and total protein levels, alongside decreased inflammatory markers and improved immune function.</p><p><strong>Conclusion: </strong>This systematic review provides compelling evidence supporting the integration of ERAS protocols into standard colorectal surgical practices. Future studies should aim to explore the variations in ERAS implementation, pinpoint the most impactful elements of ERAS, and work towards personalizing and standardizing these protocols across clinical settings. Additionally, evaluating long-term outcomes will help refine ERAS strategies, ensuring their enduring impact on patient recovery.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"4"},"PeriodicalIF":2.6,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11737126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring strategies to enhance patient safety in spine surgery: a review.","authors":"Kimia Baradaran, Constana Gracia, Ehsan Alimohammadi","doi":"10.1186/s13037-025-00426-2","DOIUrl":"10.1186/s13037-025-00426-2","url":null,"abstract":"<p><p>Patient safety is the foundation of spine surgery, where the intricate nature of spinal procedures and the unique risks involved call for exceptional diligence and comprehensive protocols. In this high-stakes field, developing and implementing rigorous safety protocols is not only vital for minimizing complications but also for achieving the best possible outcomes and strengthening the confidence patients have in their care team. Each patient entrusts their well-being to their surgical team. This trust underscores the responsibility healthcare providers have to prioritize safety at every stage. In spine surgery, thorough preoperative planning, clear communication during informed consent, and vigilant postoperative care are all crucial for creating a safe environment tailored to each patient's needs. A commitment to patient safety requires more than individual efforts; it calls for a coordinated, multidisciplinary approach where surgeons, nurses, anesthesiologists, and rehabilitation specialists work closely together. This collaboration ensures that each step of the patient's journey is aligned with best practices for safety and care. This review highlights the critical need for ongoing evaluation and refinement of safety protocols in spine surgery. As surgical techniques and technologies advance, and as patients' needs evolve, healthcare teams must remain responsive, cultivating a culture of safety that is both proactive and adaptable. Continuous investment in quality improvement and research is essential to fine-tune these protocols, ensuring they remain both relevant and effective in addressing the unique challenges of spine surgery. Prioritizing comprehensive safety measures goes beyond improving surgical outcomes; it plays a pivotal role in strengthening the trust and confidence patients have in their healthcare providers. By committing to these robust protocols, we reaffirm our dedication to patient-centered care, enhancing not only patient safety and recovery but also fostering a deeper faith in a healthcare system that places patient well-being at the forefront.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"3"},"PeriodicalIF":2.6,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11730817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the AO/OTA fracture classification dictate the anesthesia modality for the surgical management of unstable distal radius fractures? - A retrospective cohort study in 127 patients managed by general vs. regional anesthesia.","authors":"Sascha Halvachizadeh, Merav Dreifuss, Thomas Rauer, Anne Kaiser, Dirk Ubmann, Hans-Christoph Pape, Florin Allemann","doi":"10.1186/s13037-024-00423-x","DOIUrl":"10.1186/s13037-024-00423-x","url":null,"abstract":"<p><strong>Introduction: </strong>Regional anesthesia increases in popularity in orthopaedic surgery. It is usually applied in elective surgeries of the extremities. The aim of this study was to assess indication of the use of general anesthesia in the surgical treatment of distal radius fractures.</p><p><strong>Methods: </strong>Patients undergoing surgical fixation for distal radius fractures between January 1st, 2020, and December 31st, 2021, were included. Exclusion criteria encompassed incomplete 12-month follow-up, transferred or multiply injured patients, those with prior upper limb fractures, or admission for revision surgeries. Patients were categorized by anesthesia type: GA or plexus block anesthesia (PA). Primary outcomes comprised tourniquet utilization and duration of surgery, while secondary outcomes encompassed complications (e.g., complex regional pain syndrome [CRPS], local wound infection, implant removal necessity) and range of motion at three, six, and twelve months post-surgery. Fractures were classified using the AO/OTA system.</p><p><strong>Results: </strong>The study enrolled 127 patients, with 90 (70.9%) in Group GA and 37 (29.1%) in Group PA. Mean patient age was 56.95 (± 18.59) years, with comparable demographics and fracture distribution between groups. Group GA exhibited higher tourniquet usage (96.7% vs. 83.8%, p = 0.029) and longer surgery durations (85.17 ± 37.8 min vs. 65.0 ± 23.0 min, p = 0.013). Complication rates were comparable, Group GA 12.2% versus Group PA 5.4% p = 0.407, OR 2.44; 95%CI 0.51 to 11.58, p = 0.343). Short-term functional outcomes favored Group PA at three months (e.g., Pronation: 81.1° ± 13.6 vs. 74.3° ± 17.5, p = 0.046).</p><p><strong>Conclusion: </strong>Solely classifying distal radius fractures does not dictate anesthesia choice. Complexity of injury, anticipated surgery duration, less use of tourniquet, and rehabilitation duration may guide regional anesthesia utilization over GA in distal radius fracture fixation.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"2"},"PeriodicalIF":2.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11716251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting loss of independence among geriatric patients following gastrointestinal surgery.","authors":"Michaela R Cunningham, Christopher L Cramer, Ruyun Jin, Florence E Turrentine, Victor M Zaydfudim","doi":"10.1186/s13037-024-00424-w","DOIUrl":"10.1186/s13037-024-00424-w","url":null,"abstract":"<p><strong>Background: </strong>While existing risk calculators focus on mortality and complications, elderly patients are concerned with how operations will affect their quality of life, especially their independence. We sought to develop a novel clinically relevant and easy-to-use score to predict elderly patients' loss of independence after gastrointestinal surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included patients age ≥ 65 years enrolled in the American College of Surgeons National Surgical Quality Improvement Program database and Geriatric Pilot Project who underwent pancreatic, colorectal, or hepatic surgery (January 1, 2014- December 31, 2018). Primary outcome was loss of independence - discharge to facility other than home and decline in functional status. Patients from 2014 to 2017 comprised the training data set. A logistic regression (LR) model was generated using variables with p < 0.2 from the univariable analysis. The six factors most predictive of the outcome composed the short LR model and scoring system. The scoring system was validated with data from 2018.</p><p><strong>Results: </strong>Of 6,510 operations, 841 patients (13%) lost independence. Training and validation datasets had 5,232 (80%) and 1,278 (20%) patients, respectively. The six most impactful factors in predicting loss of independence were age, preoperative mobility aid use, American Society of Anesthesiologists classification, preoperative albumin, non-elective surgery, and race (all OR > 1.83; p < 0.001). The odds ratio of each of these factors were used to create a sixteen-point scoring system. The scoring system demonstrated satisfactory discrimination and calibration across the training and validation datasets, with Receiver Operating Characteristic Area Under the Curve 0.78 in both and Hosmer-Lemeshow statistic of 0.16 and 0.34, respectively.</p><p><strong>Conclusions: </strong>This novel scoring system predicts loss of independence for geriatric patients after gastrointestinal operations. Using readily available variables, this tool can be applied in the urgent setting and can contribute to elderly patients and their family discussions related to loss of independence prior to high-risk gastrointestinal operations. The applicability of this scoring tool to additional surgical sub-specialties and external validation should be explored in future studies.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"1"},"PeriodicalIF":2.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}