医学
十二指肠开关
计算器
委派
袖状胃切除术
外科
胃分流术
体质指数
逻辑回归
风险评估
医疗保健
普通外科
肥胖
内科学
减肥
经济
医学教育
操作系统
经济增长
计算机科学
计算机安全
作者
Arielle Grieco,Kristopher M. Huffman,Mark E. Cohen,Bruce L. Hall,John M. Morton,Clifford Y. Ko
标识
DOI:10.1016/j.soard.2021.02.005
摘要
Background There is increasing demand for data-driven tools that provide accurate and clearly communicated patient-specific information. These can aid discussions between practitioners and patients, promote shared decision-making, and enhance informed consent. The American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) sought to create a risk calculator for adult patients considering primary metabolic and bariatric surgery, with multiple prediction features: (1) 30-day risk; (2) 1-year body mass index projections; and (3) 1-year co-morbidity remission. Objectives To evaluate the 30-day risk estimation feature of this tool. Setting Not-for-profit organization, international bariatric surgery clinical data registry. Methods MBSAQIP data across 5.5 years, 925 hospitals, and 775,291 cases were used to develop the 30-day risk feature. Logistic regression models were employed to estimate postoperative risks for 9 outcomes across 4 procedures: laparoscopic Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, laparoscopic adjustable gastric band, and biliopancreatic diversion with duodenal switch. Results The tool showed good discrimination for mortality and surgical site infection models (c-statistics, .80 and .70, respectively), and was slightly less accurate for the 7 other complications (.62–.69). Graphical representations showed excellent calibration for all 9 outcomes. Conclusions Overall, the 30-day risk models were accurate and well calibrated, with acceptable discrimination. The MBSAQIP bariatric surgical risk/benefit calculator is publicly available, with the intent to be integrated into healthcare practice to guide bariatric surgical decision-making and care planning, and to enhance communication between patients and their surgical care team.
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