using the risk calculator. Three additional cases ( 2
percent) used the calculator for the wrong procedure.
After excluding these 16 M&M presentations, 108 ( 87
percent) cases were deemed appropriate for analysis.
The median age of patients discussed in these
M&M presentations was 59 years old. A total of 73
cases ( 68 percent) were elective while 35 cases were
classified as urgent/emergent ( 32 percent). Of the 90
M&M cases ( 83 percent) that involved intra-abdominal
operations, 58 ( 64 percent) were open procedures, and
the remaining 32 ( 36 percent) were laparoscopic or
endoscopic cases. Residents used the “surgeon adjustment” function in 21 ( 19 percent) cases to estimate that
their patients were actually at higher risk than the calculator had determined independently.
The ACS NSQIP Surgical Risk Calculator estimated
What it means
that 61 patients were at “above average” risk ( 56 per-
cent) for the primary complication they developed.
In contrast, 29 patients ( 27 percent) were estimated
to be at “below average” risk, and the remaining 18
( 17 percent) were estimated to be at “average” risk
(see Figure 2, page 31). Of the 29 patients who were
at “below average” risk, the most common compli-
cations were return to operating room ( 10 patients,
or 34 percent) and venous thromboembolism (seven
patients, or 24 percent). Eight of the “below average”
cases involved procedures that had CPT codes that
could not be accurately captured using the ACS NSQIP
Surgical Risk Calculator, including single incision lapa-
roscopy ( 2), robotics ( 2), and laparoscopic conversion
to open ( 4).
To our knowledge, this is the first article to describe
the use of the ACS NSQIP Surgical Risk Calculator
during weekly M&M conference as a tool for educating surgery residents on risk assessment and quality
improvement. Our findings confirm that it is feasible
to have surgery residents incorporate the risk calculator in M&M presentations and that the ACS NSQIP
Surgical Risk Calculator may serve as an important
tool for educating surgery residents about the importance of risk assessment and quality improvement.
This innovative approach to M&M arguably touches
on all six of the Accreditation Council for Graduate
Medical Education (ACGME) core competencies of
resident education: patient care and technical skills,
medical knowledge, practice-based learning and
improvement, interpersonal and communication
skills, professionalism, and systems-based practice. 8
An important next step of this study is to measure
the effect on resident education of using the risk calculator during M&M presentation.
FIGURE 1. ACS NSQIP SURGICAL RISK CALCULATOR
V101 No 12 BULLETIN American College of Surgeons