Document Detail

Accuracy of the surgeons' clinical prediction of perioperative complications using a visual analog scale.
MedLine Citation:
PMID:  17674096     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The ability to predict who will develop perioperative complications remains difficult because the etiology of adverse events is multifactorial. This study examines the preoperative and postoperative ability of the surgeon to predict complications and assesses the significance of a change in prediction. METHODS: This was a prospective study of 1013 patients. The surgeon assessed the risk of a major complication on a 100-mm visual analog scale (VAS) immediately before and after surgery. When the VAS score was changed, the surgeon was asked to document why. Patients were assessed up to 30 days postoperatively. RESULTS: Surgeons made a meaningful preoperative prediction of major complications (median score = 27 mm vs. 19 mm, p < 0.01), with an area under the receiver operating characteristic curve of 0.74 for mortality, 0.67 for major complications, and 0.63 for all complications. A change in the VAS score postoperatively was due to technical reasons in 74% of stated cases. An increased VAS score identified significantly more complications, but the improvement in the discrimination was small. When included in a multivariate model for predicting postoperative complications, the surgeon's VAS score functioned as an independent predictive variable and improved the predictive ability, goodness of fit, and discrimination of the model. CONCLUSIONS: Clinical assessment of risk by the surgeon using a VAS score independently improves the prediction of perioperative complications. Including the unique contribution of the surgeon's clinical assessment should be considered in models designed to predict the risk of surgery.
John C Woodfield; Ross A Pettigrew; Lindsay D Plank; Michael Landmann; Andre M van Rij
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of surgery     Volume:  31     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-17     Completed Date:  2007-12-20     Revised Date:  2008-06-03    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1912-20     Citation Subset:  IM    
Department of Surgery, University of Otago, Dunedin, New Zealand.
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MeSH Terms
Aged, 80 and over
Area Under Curve
Decision Making
Health Status Indicators
Middle Aged
Outcome Assessment (Health Care) / methods*
Pain Measurement*
Postoperative Complications / epidemiology*
Prospective Studies
ROC Curve
Risk Assessment / methods
Comment In:
World J Surg. 2008 Feb;32(2):324-5; author reply 326-7   [PMID:  17938999 ]
World J Surg. 2007 Oct;31(10):1909-11   [PMID:  17661189 ]

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