Comparison of National Surgical Quality Improvement Program Surgical Risk Calculator and Trauma and Injury Severity Score Risk Assessment Tools in Predicting Outcomes in High-Risk Operative Trauma Patients

Authors

Jeffrey Santos
Catherine M Kuza
Xi Luo
Babatunde Ogunnaike
M Iqbal Ahmed
Emily Melikman
Tiffany Moon
Thomas Shoultz
Anne Feeler
Roman Dudaryk
Jose Navas
Georgia Vasileiou
D Dante Yeh
Kazuhide Matsushima
Matthew Forestiere
Tiffany Lian
Areg Grigorian
Joni Ricks-Oddie
Jeffry Nahmias

Language

English

Publication Date

10-1-2023

Journal

The American Surgeon™

DOI

10.1177/00031348231175488

PMID

37173283

Abstract

Background: The Trauma and Injury Severity Score (TRISS) uses anatomic/physiologic variables to predict outcomes. The National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP-SRC) includes functional status and comorbidities. It is unclear which of these tools is superior for high-risk trauma patients (American Society of Anesthesiologists Physical Status (ASA-PS) class IV or V). This study compares risk prediction of TRISS and NSQIP-SRC for mortality, length of stay (LOS), and complications for high-risk operative trauma patients.

Methods: This is a prospective study of high-risk (ASA-PS IV or V) trauma patients (≥18 years-old) undergoing surgery at 4 trauma centers. We compared TRISS vs NSQIP-SRC vs NSQIP-SRC + TRISS for ability to predict mortality, LOS, and complications using linear, logistic, and negative binomial regression.

Results: Of 284 patients, 48 (16.9%) died. The median LOS was 16 days and number of complications was 1. TRISS + NSQIP-SRC best predicted mortality (AUROC: .877 vs .723 vs .843, P = .0018) and number of complications (pseudo-R2/median error (ME) 5.26%/1.15 vs 3.39%/1.33 vs 2.07%/1.41, P < .001) compared to NSQIP-SRC or TRISS, but there was no difference between TRISS + NSQIP-SRC and NSQIP-SRC with LOS prediction (P = .43).

Discussion: For high-risk operative trauma patients, TRISS + NSQIP-SRC performed better at predicting mortality and number of complications compared to NSQIP-SRC or TRISS alone but similar to NSQIP-SRC alone for LOS. Thus, future risk prediction and comparisons across trauma centers for high-risk operative trauma patients should include a combination of anatomic/physiologic data, comorbidities, and functional status.

Keywords

Humans, Adolescent, Quality Improvement, Prospective Studies, Injury Severity Score, Risk Assessment, Surgical Wound, Postoperative Complications, National Surgical Quality Improvement Program Surgical Risk Calculator, Trauma and Injury Severity Score, complications, high-risk, length of stay, mortality

Published Open-Access

yes

Recommended Citation

Santos, Jeffrey; Kuza, Catherine M; Luo, Xi; et al., "Comparison of National Surgical Quality Improvement Program Surgical Risk Calculator and Trauma and Injury Severity Score Risk Assessment Tools in Predicting Outcomes in High-Risk Operative Trauma Patients" (2023). Faculty, Staff and Student Publications. 1213.
https://digitalcommons.library.tmc.edu/uthsph_docs/1213