Prognostic value of preop surgeon intuition vs ACS-NSQIP risk calculator

Editor's Note

This study by researchers from Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, finds that preoperative surgeon intuition is an independent predictor of postoperative complications, but it isn’t as strong as the predictive power of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk calculator—a tool used to estimate patient-specific postoperative complication risks for almost all surgical procedures.

The analysis included 216 preoperative patient assessments by surgeons and NSQIP data on 9,182 general surgery patients. After comparing surgeon assessments with the risk calculator, the researchers built a third model that combined both.

Among the findings:

• A model of preoperative surgeon intuition predicting complications had an area under the curve (AUC) of 0.70, where an AUC of 1.0 is a perfect prediction and 0.5 is a random result.
• Surgeon intuition was less accurate than the ACS-NSQIP risk calculator, which had an AUC of 0.83.
• A combined model of surgeon intuition and the risk calculator did not do better than the risk calculator alone, with an AUC of 0.83.
• A subset analysis showed that intuition of more experienced attending surgeons was more accurate in predicting patient outcomes than less experienced residents.

The researchers concluded that preoperative surgeon intuition alone is an independent predictor of patient outcomes; however, the ACS-NSQIP risk calculator is a more robust predictor of postoperative complications.