Date of Award

1-1-2019

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)

Department

Yale University School of Nursing

First Advisor

Marjorie Funk

Second Advisor

Ruth McCorkle

Abstract

Introduction

Surgeon perception of surgical risk varies. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP®) Surgical Risk Calculator (SRC) estimates risk of postoperative outcomes and can assist with communicating risks to patients preoperatively. We compared surgeon risk estimates with calculations of risk from the SRC.

Methods

In this project in 2 medical centers, 10 surgeons completed a tool in which they estimated the risk of complications for patients undergoing elective surgical procedures. A NSQIP-trained reviewer determined SRC estimates for the same patients. Agreement was determined using Bland-Altman and Lin’s concordance statistics.

Results

In the evaluation of 74 patients, agreement was present between surgeons and the SRC for only “serious complication”. For the remaining outcomes, surgeons tended to estimate higher risk than the SRC.

Conclusions

For general surgical procedures, use of the SRC may add value to the surgeon-patient shared decision-making processes.

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