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Novel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes
Background Despite the existence of multiple validated risk-assessment and quality benchmarking tools in surgery, their utility outside of High Income Countries is limited. We sought to derive, validate and apply a scoring system that is both 1) feasible, and 2) reliably predicts mortality in a Mi...
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| Format: | Thesis |
| Language: | English |
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Department of Surgery
2019
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| _version_ | 1867613506329640960 |
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| access_status_str | Open Access |
| author | Spence, Richard Trafford |
| author2 | Panieri, Eugenio |
| author_browse | Panieri, Eugenio Spence, Richard Trafford |
| author_facet | Panieri, Eugenio Spence, Richard Trafford |
| author_sort | Spence, Richard Trafford |
| collection | Thesis |
| description | Background
Despite the existence of multiple validated risk-assessment and quality benchmarking tools in surgery, their utility outside of High Income Countries is limited. We sought to derive, validate and apply a scoring system that is both 1) feasible, and 2) reliably predicts mortality in a Middle Income Country (MIC) context.
Methods
A 5-step methodology was used: 1. Development of a de novo surgical outcomes database modeled around the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) in South Africa (SA Dataset) 2. Use of the resultant data to identify all predictors of in-hospital death with more than 90% capture indicating feasibility of collection 3. Use these predictors to derive and validate an integer-based score that reliably predicts in-hospital death in the 2012 ACS-NSQIP 4. Apply the score in the original SA dataset and demonstrate it’s performance 5. Identify threshold cutoffs of the score to prompt action and drive quality improvement.
Results
Following Step one-three above, the 13 point Codman’s score was derived and validated on 211,737 and 109,079 patients, respectively, and includes: 1) age≥65 (1), partially or completely dependent functional status (1), preoperative transfusions≥4 units (1), emergency operation (2), sepsis or septic shock (2) American Society of Anesthesia (ASA) score ≥3 (3) and operative procedure (1-3). Application of the score to 373 patients in the SA dataset showed good discrimination and calibration to predict an inhospital death. A Codman Score of 8 is an optimal cutoff point for defining expected and unexpected deaths.
Conclusion
We have designed a novel risk prediction score specific for a MIC context. The Codman Score can prove useful for both 1) preoperative decision-making and 2) benchmarking the quality of surgical care in MIC’s. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/29635 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:37:13.959Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2019 |
| publishDateRange | 2019 |
| publishDateSort | 2019 |
| publisher | Department of Surgery |
| publisherStr | Department of Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/29635 Novel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes Spence, Richard Trafford Panieri, Eugenio Surgery Background Despite the existence of multiple validated risk-assessment and quality benchmarking tools in surgery, their utility outside of High Income Countries is limited. We sought to derive, validate and apply a scoring system that is both 1) feasible, and 2) reliably predicts mortality in a Middle Income Country (MIC) context. Methods A 5-step methodology was used: 1. Development of a de novo surgical outcomes database modeled around the American College of Surgeons’ National Surgical Quality Improvement Program (ACS-NSQIP) in South Africa (SA Dataset) 2. Use of the resultant data to identify all predictors of in-hospital death with more than 90% capture indicating feasibility of collection 3. Use these predictors to derive and validate an integer-based score that reliably predicts in-hospital death in the 2012 ACS-NSQIP 4. Apply the score in the original SA dataset and demonstrate it’s performance 5. Identify threshold cutoffs of the score to prompt action and drive quality improvement. Results Following Step one-three above, the 13 point Codman’s score was derived and validated on 211,737 and 109,079 patients, respectively, and includes: 1) age≥65 (1), partially or completely dependent functional status (1), preoperative transfusions≥4 units (1), emergency operation (2), sepsis or septic shock (2) American Society of Anesthesia (ASA) score ≥3 (3) and operative procedure (1-3). Application of the score to 373 patients in the SA dataset showed good discrimination and calibration to predict an inhospital death. A Codman Score of 8 is an optimal cutoff point for defining expected and unexpected deaths. Conclusion We have designed a novel risk prediction score specific for a MIC context. The Codman Score can prove useful for both 1) preoperative decision-making and 2) benchmarking the quality of surgical care in MIC’s. 2019-02-18T11:29:22Z 2019-02-18T11:29:22Z 2018 2019-02-15T08:24:44Z Master Thesis Masters MMed http://hdl.handle.net/11427/29635 eng application/pdf Department of Surgery Faculty of Health Sciences University of Cape Town |
| spellingShingle | Surgery Spence, Richard Trafford Novel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes |
| thesis_degree_str | Master's |
| title | Novel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes |
| title_full | Novel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes |
| title_fullStr | Novel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes |
| title_full_unstemmed | Novel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes |
| title_short | Novel Approaches to Global Benchmarking of Risk-Adjusted Surgical Outcomes |
| title_sort | novel approaches to global benchmarking of risk adjusted surgical outcomes |
| topic | Surgery |
| url | http://hdl.handle.net/11427/29635 |
| work_keys_str_mv | AT spencerichardtrafford novelapproachestoglobalbenchmarkingofriskadjustedsurgicaloutcomes |