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Another important finding of the study is related to the fact
that most of these M&M cases were considered to have an “above
average” risk for the complication ultimately developed by the
patient. Several “below average” cases, as well as those M&M
cases that did not involve the ACS NSQIP Surgical Risk Calculator, were for procedures that did not have CP T codes that could
be accurately captured using the risk calculator. Future studies
should focus on validating this tool’s ability to estimate the risk
of complications for particular circumstances, including laparoscopic conversion to open, single-incision laparoscopic surgery,
and robotic surgery.
Another possible next step for future research is to use the
ACS NSQIP Surgical Risk Calculator as part of M&M case selection. Whereas our study found the highest proportion of M&M
cases was composed of above-average risk complications, perhaps the risk calculator should be used to identify below-average
risk cases for M&M presentation. These below-average risk cases
may indicate postoperative complications that are worth discussing to highlight areas for quality improvement.
It should be noted that our study had several limitations.
First, it involved a retrospective chart review, and selection of
cases for M&M presentation was subjective, leading to a potentially biased cohort. Furthermore, the study was not designed
to validate the ACS NSQIP Surgical Risk Calculator or detect
any statistically significant differences in complication rates.
This was not a stated objective of our study, however, because
our primary goal was to provide a qualitative description of our
experience using the risk calculator.
Nevertheless, our study demonstrates the feasibility of using
the ACS NSQIP Surgical Risk Calculator as part of surgical education during M&M presentations. Future studies are needed
to determine the effect of this important tool on uptake of the
ACGME core competencies. ♦
This topic was presented as a poster and oral presentation at the 2016
ACS NSQIP Annual Conference Monday, July 18, in San Diego, CA.
FIGURE 2. ACS NSQIP SURGICAL RISK CALCULATOR
ESTIMATION OF POSTOPERATIVE RISK
AMONG M&M CASE PRESENTATIONS
DEC 2016 BULLETIN American College of Surgeons