Man against the machine - Differences in surgical risk evaluation. A cohort prospective study. (December 2018) - Hacohen Solovitz, Amir
Abstract: Background: The aim of this study was to compare the assessment provided by the ACS Surgical Risk Calculator with the assessments provided by senior and resident anesthesiologists. Methods: The study is prospective and controlled. Before the surgical procedure a resident anesthesiologist collected data needed to perform pre-operative assessment. Then, based on this data, a risk assessment was carried out by resident and senior anesthesiologists and by the online ACS Surgical Risk Calculator. Then the three evaluations were compared. Demographic and clinical data were gathered to determine risk factors and complication rates. Results: One hundred patients who were scheduled for a surgical procedure were recruited for the study. A difference was found among the different estimations. In most parameters the resident anesthesiologists more resembled the ACS assessment than the senior anesthesiologists. The following differences in risk assessment were found: possible complication in the course of the surgery (4.4% ACS calculator, 1% senior anesthesiologists, 2.2% resident anesthesiologists), and for a life-threatening complication (3.6% ACS calculator, 0.5% senior anesthesiologists, 2.4% resident anesthesiologists). In assessing death, urinary tract and surgical sites infections the seniors difference to the ACS calculator was statistically significant (p < 0.05). Seniors resembled better cardiac complications (p < 0.05) and both resident and senior anesthesiologists failed to resemble the ACS calculator in assessing return to the operating room and pneumonia (p < 0.05). Conclusions: Both senior and resident anesthesiologists failed to estimate the surgical risks based on preoperative data. Further study involving the surgeons and comparing the estimated to the actual complication rates are needed.