Home Calculator may predict likelihood of home discharge after surgery

Image: PD 

1. An interview-based five question calculator predicts the risk of a patient not being able to go home after surgery. 

2. This tool was validated across multiple surgical specialties using the ACS NSQIP database. 

Evidence Rating Level: 2 (Good)

Study Rundown: Before surgery, patients are instructed to hope for the best and prepare for the worst, all without knowing the exact risk of complications. This study’s authors derived and validated a Home Calculator that uses preoperative factors to predict the risk of a patient not going home after surgery. This tool can be utilized by surgeons in a variety of surgical specialties to help patients understand his or her individualized risk. While it is retrospective in nature, this is a generalizable study that includes a large number of patients and boasts a comprehensive statistical analysis of recent data. The downside of the tool is that a healthcare provider must spend time to explain the calculator’s questions and interpret the resulting risk percentage. This could be a barrier to wide implementation of the calculator. Additionally, the true risk of not being discharged home varies by hospital and provider.

Click to read the study in JACS

Relevant Reading: The Patient-Centered Outcomes Research Institute (PCORI) national priorities for research and initial research agenda

In-Depth [retrospective cohort]: This study analyzed 88,068 patients from the ACS NSQIP database of rigorously collected data from over 400 institutions to create the Home Calculator, a score that predicts home discharge after surgery. To validate the calculator, patients were split into two cohorts: 72,591 general surgery and 16,102 vascular surgery patients. The data was further validated in other specialties including gynecology (17,005), urology (14,435), thoracic (5,092) surgery and orthopedics (19,514), excluding knee and hip arthroplasty. Primary outcome was patient’s discharge to home or “other,” defined as patients passing away or going to facilities where they was not previously living. After discharge 86.6% of patients went home and 2.4% died. Authors used predicted morbidity and mortality as benchmarking predictors of home discharge to reference the Home Calculator. The calculator asks the patient five questions: age, whether the surgery is elective, level of independence with daily activities, whether they living at home prior to surgery and ASA performance status.

By Asya Ofshteyn and Allen Ho

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