Documentation of individualized preoperative risk assessment: a multi-center study
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RESEARCH
Open Access
Documentation of individualized preoperative risk assessment: a multi-center study Joshua A. Bloomstone1,2,3,4* , Benjamin T. Houseman1, Evora Vicents Sande1, Ann Brantley1, Jessica Curran5, Gerald A. Maccioli6, Tania Haddad1, James Steinshouer7, David Walker3 and Ramani Moonesinghe3
Abstract Background: Individual surgical risk assessment (ISRA) enhances patient care experience and outcomes by informing shared decision-making, strengthening the consent process, and supporting clinical management. Neither the use of individual pre-surgical risk assessment tools nor the rate of individual risk assessment documentation is known. The primary endpoint of this study was to determine the rate of physician documented ISRAs, with or without a named ISRA tool, within the records of patients with poor outcomes. Secondary endpoints of this work included the effects of age, sex, race, ASA class, and time and type of surgery on the rate of documented presurgical risk. Methods: The records of non-obstetric surgical patients within 22 community-based private hospitals in Arizona, Colorado, Nebraska, Nevada, and Wyoming, between January 1 and December 31, 2017, were evaluated. A twosample proportion test was used to identify the difference between surgical documentation and anesthesiology documentation of risk. Logistic regression was used to analyze both individual and group effects associated with secondary endpoints. Results: Seven hundred fifty-six of 140,756 inpatient charts met inclusion criteria (0.54%, 95% CI 0.50 to 0.58%). ISRAs were documented by 16.08% of surgeons and 4.76% of anesthesiologists (p < 0.0001, 95% CI −0.002 to 0.228). Cardiac surgeons documented ISRAs more frequently than non-cardiac surgeons (25.87% vs 16.15%) [p = 0.0086, Rsquared = 0.970%]. Elective surgical patients were more likely than emergency surgical patients (19.57 vs 12.03%) to have risk documented (p = 0.023, R-squared = 0.730%). Patients over the age of 65 were more likely than patients under the age of 65 to have ISRA documentation (20.31 vs 14.61%) [p = 0.043, R-squared = 0.580%]. Only 10 of 756 (1.3%) records included documentation of a named ISRA tool. Conclusions: The observed rate of documented ISRA in our sample was extremely low. Surgeons were more likely than anesthesiologists to document ISRA. As these individualized risk assessment discussions form the bedrock of perioperative informed consent, the rate and quality of risk documentation must be improved. Keywords: Individual risk assessment, Surgical risk assessment, Perioperative risk assessment, Risk score, Risk tool, Population risk, Individual risk
* Correspondence: [email protected] 1 Envision Physician Services, 7700 West Sunrise BLVD, Plantation, FL 33322, USA 2 Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 Inte
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