Decreasing 30-day surgical mortality in a VA Medical Center utilizing the ACS NSQIP Surgical Risk Calculator

J Surg Res. 2017 Jul;215:28-33. doi: 10.1016/j.jss.2017.03.030. Epub 2017 Apr 1.


Background: The Overton Brooks VA Medical Center Surgical Service had a high mortality. In an effort to reduce surgical mortality, we implemented a series of quality improvement interventions, including utilization of the ACS Surgical Risk Calculator to identify high-risk surgical patients for discussion in a multidisciplinary Pre-Operative Consultation Committee.

Methods: Retrospective study describing the implementation of a risk stratification intervention incorporating the ACS Surgical Risk Calculator Tool and a multidisciplinary Pre-Operative Consultation Committee to target high-risk patients. Measurement of 30 day surgical mortality and risk adjusted Observed to Expected (O/E) mortality ratio.

Results: From May 2013 to September 2014, 614 high-risk patients were selected utilizing the ACS Risk Calculator and presented at the Pre-Operative Consultation Committee. Following implementation of this risk stratification intervention, 30-day mortality decreased by 66% from 0.9% to 0.3%, and risk adjusted O/E mortality ratio decreased from 2.5 to 0.8. Among the high risk patients presented, there was no increase in referrals to other facilities. There was a significant increase in cases requiring further preoperative optimization, from 6.3% at the beginning of the study period to 17.5% at the end of the study period.

Conclusions: Implementation of a preoperative risk stratification intervention utilizing the ACS Surgical Risk Calculator along with a multidisciplinary Pre-Operative Consultation Committee can be successfully accomplished, with a significant decrease in 30-day surgical mortality. This is the first published report of utilization of the ACS Risk calculator as part of a systematic quality improvement tool to decrease surgical mortality.

Keywords: Patient safety; Perioperative mortality; Quality improvement; Surgical risk calculator.

MeSH terms

  • Decision Support Techniques*
  • Hospitals, Veterans / standards*
  • Hospitals, Veterans / statistics & numerical data
  • Humans
  • Louisiana
  • Quality Improvement / statistics & numerical data*
  • Quality Indicators, Health Care / statistics & numerical data*
  • Retrospective Studies
  • Risk Adjustment
  • Risk Assessment
  • Surgery Department, Hospital / standards*
  • Surgery Department, Hospital / statistics & numerical data
  • Surgical Procedures, Operative / mortality*