Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Vital Functions, University Medical Centre Utrecht, Utrecht, The Netherlands.
BMC Anesthesiol. 2024 Oct 30;24(1):392. doi: 10.1186/s12871-024-02771-8.
Multiple preoperative calculators are available online to predict preoperative mortality risk for noncardiac surgical patients. However, it is currently unknown how these risk calculators perform across different raters. The current study investigated the interrater reliability of three preoperative mortality risk calculators in an elective high-risk noncardiac surgical patient population to evaluate if these calculators can be safely used for identification of high-risk noncardiac surgical patients for a preoperative multidisciplinary team discussion.
Five anesthesiologists assessed the preoperative mortality risk of 34 high-risk patients using the preoperative score to calculate postoperative mortality risks (POSPOM), the American College of Surgeons surgical risk calculator (SRC), and the surgical outcome risk tool (SORT). In total, 170 calculations per calculator were gathered.
Interrater reliability was poor for SORT (ICC (C.I. 95%) = 0.46 (0.30-0.63)) and moderate for SRC (ICC = 0.65 (0.51-0.78)) and POSPOM (ICC = 0.63 (0.49-0.77). The absolute range of calculated mortality risk was 0.2-72% for POSPOM, 0-36% for SRC, and 0.4-17% for SORT. The coefficient of variation increased in higher risk classes for POSPOM and SORT. The extended Bland-Altman limits of agreement suggested that all raters contributed to the variation in calculated risks.
The current results indicate that the preoperative risk calculators POSPOM, SRC, and SORT exhibit poor to moderate interrater reliability. These calculators are not sufficiently accurate for clinical identification and preoperative counseling of high-risk surgical patients. Clinicians should be trained in using mortality risk calculators. Also, clinicians should be cautious when using predicted mortality estimates from these calculators to identify high-risk noncardiac surgical patients for elective surgery.
目前有多种在线术前计算器可用于预测非心脏手术患者的术前死亡风险。然而，目前尚不清楚这些风险计算器在不同评估者之间的表现如何。本研究调查了三种术前死亡风险计算器在择期高危非心脏手术患者人群中的组内可靠性，以评估这些计算器是否可安全用于识别高危非心脏手术患者以进行术前多学科团队讨论。
五名麻醉师使用术前评分计算术后死亡率风险（POSPOM）、美国外科医师学会手术风险计算器（SRC）和手术结局风险工具（SORT）评估 34 名高危患者的术前死亡风险。每个计算器共收集了 170 次计算结果。
SORT 的组内可靠性较差（ICC（95%CI）=0.46（0.30-0.63）），而 SRC 和 POSPOM 的组内可靠性为中等（ICC=0.65（0.51-0.78））和 0.63（0.49-0.77）。计算得出的死亡率风险的绝对值范围为 POSPOM 为 0.2-72%，SRC 为 0-36%，SORT 为 0.4-17%。POSPOM 和 SORT 的风险类别越高，变异系数越大。扩展的 Bland-Altman 一致性界限表明，所有评估者均对计算出的风险的变异性有贡献。
目前的结果表明，POSPOM、SRC 和 SORT 这三种术前风险计算器的组内可靠性差至中等。这些计算器对于临床识别和高危手术患者的术前咨询不够准确。临床医生应该接受使用死亡率风险计算器的培训。此外，临床医生在使用这些计算器预测的死亡率估计值来识别择期非心脏手术的高危患者时应谨慎。
