Introduction: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online Surgical Risk Calculator uses inherent patient characteristics to provide predictive risk scores for adverse postoperative events. The purpose of our study is the determine if neurosurgical spine patients with a high predicted risk scores are associated with increased in-hospital costs.
Methods: A single-center retrospective review of 192 neurosurgical spine patients treated in the period from September 2011 through December 2014 was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted risk scores were compared with actual in-hospital costs obtained from a billing database. Statistical models were used to determine if patients with higher risk scores were associated with increased in-hospital costs.
Results: We used the pearson correlation coefficient (R) to assess correlation between 11 types of complication risk scores and 5 types of encounter costs from 192 spine UF health encounters involving spine procedures. Risk scores in categories such as serious complication, any complication, pneumonia, cardiac complication, surgical site infection, urinary tract infection, venous thromboembolism, renal failure, return to operating room, death, and discharge to nursing home or rehab were examined. Patients with higher risk scores were found to have a statistically significant association with increased in-hospital costs (p < 0.05).
Conclusions: Previous work has demonstrated the ACS NSQIP Surgical Risk Calculator can accurately predict mortality but is poorly predictive of other potential adverse events and clinical outcomes. However, this study demonstrates that high-risk patients identified by the ACS NSQIP Surgical Risk Calculator have a statistically significant association with an increase in-hospital cost. The NSQIP calculator may not accurately predict surgical risk (as demonstrated previously), given the current healthcare climate future iterations of the ACS Universal Risk Calculator may be valuable tool in predicting in-hospital costs.
Patient Care: In the current healthcare climate of value conscious care this research aims to improve patient care by creating a framework to stratify high risk patients and identify drivers of healthcare costs. Surgical risk calculators provide valuable information for both healthcare providers and patients. This study builds on prior work which demonstrated that the ACS NSQIP Surgical Risk Calculator accurately predicts mortality in neurosurgical patients but performs poorly when predicting other complications. As the ACS continues to develop the risk calculator, this study demonstrates that future iterations may be useful in predicting in-hospital costs.
Learning Objectives: By conclusion of this session participants should be able to
1. Become familiar with the ACS NSQIP Surgical Risk Calculator
2. Understand the implications of surgical risk calculator in the current healthcare climate
3. Understand how surgical risk calculators may affect neurosurgical clinical practice
References: 1. Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, et al.: Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons.. J Am Coll Surg 217:833–842, 842.e1–842.e3, 2013
2. S. Vaziri, J. Wilson, J. Abbatematteo, P. Kubilis, S. Chakraborty, K. Kshitij, et al. Predictive performance of the American College of Surgeons universal risk calculator in neurosurgical patients. J Neurosurg (2017), pp. 1-6