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Use of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator During Preoperative Risk Discussion: The Patient Perspective

Raymond, Britany L. MD*; Wanderer, Jonathan P. MD, MPhil*; Hawkins, Alexander T. MD, MPH; Geiger, Timothy M. MD, MMHC; Ehrenfeld, Jesse M. MD, MPH*; Stokes, John W. MD; McEvoy, Matthew D. MD*

doi: 10.1213/ANE.0000000000003718
Perioperative Medicine: Original Clinical Research Report

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

From the Departments of *Anesthesiology

General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.

Published ahead of print 9 July 2018.

Accepted for publication July 9, 2018.

Funding: M.D.M. discloses research funding from the GE Foundation, Edwards Lifesciences, and Cheetah Medical, none of which are related to this manuscript. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Gift card remuneration for participants was funded internally by the Department of Anesthesiology at Vanderbilt University Medical Center.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Matthew D. McEvoy, MD, Department of Anesthesiology, Office of Educational Affairs, Vanderbilt University Medical Center, 1301 Medical Center Dr, 4648 TVC, Nashville, TN 37232. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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