From the Departments of Anesthesiology.
General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Anesth Analg. 2019 Apr;128(4):643-650. doi: 10.1213/ANE.0000000000003718.
The American College of Surgeons (ACS) National Surgical Quality Improvement Program Surgical Risk Calculator (ACS Calculator) provides empirically derived, patient-specific risks for common adverse perioperative outcomes. The ACS Calculator is promoted as a tool to improve shared decision-making and informed consent for patients undergoing elective operations. However, to our knowledge, no data exist regarding the use of this tool in actual preoperative risk discussions with patients. Accordingly, we performed a survey to assess (1) whether patients find the tool easy to interpret, (2) how accurately patients can predict their surgical risks, and (3) the impact of risk disclosure on levels of anxiety and future motivations to decrease personal risk.
Patients (N = 150) recruited from a preoperative clinic completed an initial survey where they estimated their hospital length of stay and personal perioperative risks of the 12 clinical complications analyzed by the ACS Calculator. Next, risk calculation was performed by entering participants' demographics into the ACS Calculator. Participants reviewed their individualized risk reports in detail and then completed a follow-up survey to evaluate their perceptions.
Nearly 90% of participants desire to review their ACS Calculator report before future surgical consents. High-risk patients were 3 times more likely to underestimate their risk of any complication, serious complication, and length of stay compared to low-risk patients (P < .001). After reviewing their calculated risks, 70% stated that they would consider participating in prehabilitation to decrease perioperative risk, and nearly 40% would delay their surgery to do so. Knowledge of personal ACS risk calculations had no effect on anxiety in 20% and decreased anxiety in 71% of participants.
The ACS Calculator may be of particular benefit to high-risk surgical populations by providing realistic expectations of outcomes and recovery. Use of this tool may also provide motivation for patients to participate in risk reduction strategies.
美国外科医师学院（ACS）国家外科质量改进计划手术风险计算器（ACS 计算器）提供了经验衍生的、针对常见围手术期不良结局的患者特异性风险。ACS 计算器被宣传为一种工具，用于改善接受择期手术的患者的共同决策和知情同意。然而，据我们所知，目前尚无关于该工具在与患者进行实际术前风险讨论中的使用情况的数据。因此，我们进行了一项调查，以评估：(1)患者是否认为该工具易于理解；(2)患者能够多准确地预测他们的手术风险；以及 (3)风险披露对焦虑程度和未来降低个人风险的动机的影响。
从术前诊所招募的 150 名患者完成了一项初始调查，在该调查中，他们估计了他们的住院时间和 ACS 计算器分析的 12 种临床并发症的个人围手术期风险。然后，通过将参与者的人口统计学数据输入 ACS 计算器来进行风险计算。参与者详细查看了他们的个性化风险报告，然后完成了一项后续调查以评估他们的看法。
近 90%的参与者希望在未来的手术同意书之前查看他们的 ACS 计算器报告。高风险患者低估任何并发症、严重并发症和住院时间风险的可能性是低风险患者的 3 倍（P<.001）。在查看他们的计算风险后，70%的患者表示他们会考虑参加围手术期风险降低的康复治疗，近 40%的患者会因此推迟手术。71%的患者知识个人 ACS 风险计算对焦虑没有影响，而 20%的患者焦虑程度降低。
ACS 计算器通过提供对结果和恢复的现实期望，可能对高风险手术人群特别有益。使用该工具还可能为患者参与风险降低策略提供动力。
