Introduction and Background

The primary task as the consultant is to identify and evaluate available risk assessment tools for cardiac and pulmonary risk for non-cardiac surgeries. The identified tools should ideally be in peer-reviewed published literature, be validated and have the potential for implementation in an electronic health record system. In addition, each identified tool should specifically address only cardiac or pulmonary risk, however, they can address multiple aspects of each as in the case of pulmonary risk where both respiratory failure and post-operative pneumonia are important predicted outcomes or they can provide an aggregate risk estimate.

Project Purpose

To address this informatics need, identify the available preoperative risk assessment tools which can be used for preoperative cardiac risk assessment and preoperative pulmonary risk assessment. A parsimonious model is advantageous, but requires performance to be as good or better than a more complex solution.

What are the available tools?

Rate the quality of the tools

Based on peer-reviewed evidence, internal validation metrics, implementation feasibility and any other pertinent factors you deem relevant. If you use a numeric or qualitative scale, please identify the evaluation scale.

Gupta Perioperative Cardiac Risk

  • This risk calculator provides an estimate of perioperative cardiac risk for individual patients based on a model derived from a large sample (>400 000) of patients. It is used as a supplement to the provider’s own judgement. There were some limitations. For example, there was an absence of information on preoperative stress test, echocardiography, arrhythmia, and aortic valve disease.
  • I personally did not care for this model. It was not at all informative.

Revised Cardiac Risk Index for Pre-Operative Risk

  • Used to judge the benefits and risks of surgery. Decision to have surgery should be based on the total risk judged against the benefit of surgery over the next best option.
  • This tool was much easier to navigate and perform the assessment on.
  • It gave a “Risk Factor”, “Description”, and “Points”
  • Also provided an interpretation of the score, which was very useful

Surgical Outcome Risk Tool (SORT)

  • The SORT is a pre-operative risk prediction tool for death within 30 days of surgery. It has been developed and validated for use in inpatient non-neurological, non-cardiac surgery in adults (aged 16 or over).
  • When completing this tool it did print a risk t the screen, but it did not give any explanation as to what the result meant.
  • It did have some “?” buttons to assist in some of the explanations, but not for the final results

AJRR Total Joint Replacement Risk Calculator

  • This is an interactive risk calculator.
  • It is not explanatory in the least.
  • It does compare your results with those in the same demo and also against the Medicare population.

Mayo Clinic Risk Scores

  • Used Percutaneous coronary intervention (PCIs) from more than 9000 participants.
  • Calculates as the information is entered into the calculator.
  • A key is used at the bottom of the calculator for explanation

** MACE = Major Adverse Cardiac Events. (1) in-hospital death, (2) Q-wave MI, (3) urgent or emergent coronary artery bypass graft (CABG) operation, and (4) cerebrovascular accident during the index hospitalization.**

Recommendation

I would recommend the Revised Cardiac Risk Index for Pre-Operative Risk. It was, by far, the easiest to navigate and interpret the results. It provided great detail in the categories sections of the calculator, ensuring clarity. Lastly, a person can copy and then print the results, should they need them for reference.

Second best choice

Secondly, I would recommend the Mayo Clinic Risk Scores site. It also calculated the risk as the information was entered in to the calculator, but with much less explanation. There was no option to copy or print the results, but that is not that crucial since a person can print it through a different means.

Surgical Risk Calculator

The Surgical Risk Calculator was far and away the best calculator. The ease in which a novice could navigate and experiment on the site was facinating. I found myself trying out all sorts of scenarios to come up with many different results. It’s feasabililty to integrate into the EHR appeared to be a little more tricky. A person could have the results emailed, printed, and/or saved to a file. This could then be uploaded into an EHR, should a person want that.

System Usability Scale (SUS)

* 80.3 or higher is an A. People love your site and will recommend it to their friends
* 68 or thereabouts gets you a C. You're doing OK but could improve
* 51 or under gets you a big fat F. Make usability your priority now and fix this fast.

When I calculated the SUS score using an excel spreadsheet from online I got a 90. This is considered an A.

Conclusion

I feel as though the Surgical Risk Calculator that was provided in the homework was superior to all other in almost every single way. I found it to be useful and engaging, even to a person with very little experience in this area.