A lot of times we as physicians have to explain the risks and benefits of a surgical procedure to patients. Some patients want to know what are the common risks and also want to know the severity of complications. On the other hand the hospitals are currently interested in providing information to the public and to insurance companies about outcomes. Some hospital are planning to create programs that provide financial bonuses to physicians that prove that their outcomes are better compared to the outcomes of other surgeons. In addition, the Medicare and Medicaid governmental agencies are looking into penalizing hospitals that have higher rates of complications and readmissions.
The American College of Surgeons has introduced a Web based application where physicians and medical providers can calculate the risks of complications related to surgery. It is a valuable tool that I have been using when I consent patients for surgery and explain to them the "main risks" of surgery. It can be found at:
http://riskcalculator.facs.org/
I believe that this is a very valuable tool. The application was developed after studying 1,414,006 patients encompassing 1,557 unique CPT codes. A universal surgical risk calculator model was developed that had excellent performance for mortality (c-statistic = 0.944; Brier score = 0.011 [where scores approaching 0 are better]), morbidity (c-statistic = 0.816, Brier score = 0.069), and 6 additional complications (c-statistics > 0.8). Predictions were similarly robust for the universal calculator vs procedure-specific calculators (eg, colorectal). Surgeons demonstrated considerable agreement on the case scenario scoring (80% to 100% agreement), suggesting reliable score assignment between surgeons
It is interesting that not too long ago Dr Codman lost his appointment at Harvard University when he insisted in looking at outcomes, complications and introduced the morbidity and mortality conferences. Codman wrote, “We believe it is the duty of every hospital to establish a follow-up system, so that as far as possible the result of every case will be available at all times for investigation by members of the staff, the trustees, or administration, or by other authorized investigators or statisticians.” I guess sometimes looking into the too distant future can have "adverse reactions".
For those interested in learning about Codman's short biography please visit http://www.aaos.org/news/bulletin/janfeb07/research1.asp
