• Majed W El Hechi, Lydia R Maurer, Jordan Levine, Daisy Zhuo, El MohebMohamadMDivision of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA., George C Velmahos, Jack Dunn, Dimitris Bertsimas, and Haytham Ma Kaafarani.
• Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA.
• J. Am. Coll. Surg. 2021 Jun 1; 232 (6): 912-919.e1.

BackgroundThe Predictive Optimal Trees in Emergency Surgery Risk (POTTER) tool is an artificial intelligence-based calculator for the prediction of 30-day outcomes in patients undergoing emergency operations. In this study, we sought to assess the performance of POTTER in the emergency general surgery (EGS) population in particular.MethodsAll patients who underwent EGS in the 2017 American College of Surgeons NSQIP database were included. The performance of POTTER in predicting 30-day postoperative mortality, morbidity, and 18 specific complications was assessed using the c-statistic metric. As a subgroup analysis, the performance of POTTER in predicting the outcomes of patients undergoing emergency laparotomy was assessed.ResultsA total of 59,955 patients were included. Median age was 50 years and 51.3% were women. POTTER predicted mortality (c-statistic = 0.93) and morbidity (c-statistic = 0.83) extremely well. Among individual complications, POTTER had the highest performance in predicting septic shock (c-statistic = 0.93), respiratory failure requiring mechanical ventilation for 48 hours or longer (c-statistic = 0.92), and acute renal failure (c-statistic = 0.92). Among patients undergoing emergency laparotomy, the c-statistic performances of POTTER in predicting mortality and morbidity were 0.86 and 0.77, respectively.ConclusionsPOTTER is an interpretable, accurate, and user-friendly predictor of 30-day outcomes in patients undergoing EGS. POTTER could prove useful for bedside counseling of patients and their families and for benchmarking of EGS care.Copyright © 2021 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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