• Adam R Dyas, Heather Carmichael, Michael R Bronsert, William G Henderson, Helen J Madsen, Kathryn L Colborn, Catherine G Velopulos, and Robert A Meguid.
• From the Surgical Outcomes and Applied Research Program, Department of Surgery, (Dyas, Carmichael, Bronsert, Henderson, Madsen, Colborn, Velopulos, Meguid), University of Colorado School of Medicine, Aurora, CO.
• J. Am. Coll. Surg. 2022 Jun 1; 234 (6): 1137-1146.

BackgroundEmerging literature suggests that measures of social vulnerability should be incorporated into surgical risk calculators. The Social Vulnerability Index (SVI) is a measure designed by the CDC that encompasses 15 socioeconomic and demographic variables at the census tract level. We examined whether adding the SVI into a parsimonious surgical risk calculator would improve model performance.Study DesignThe eight-variable Surgical Risk Preoperative Assessment System (SURPAS), developed using the entire American College of Surgeons (ACS) NSQIP database, was applied to local ACS-NSQIP data from 2012 to 2018 to predict 12 postoperative outcomes. Patient addresses were geocoded and used to estimate the SVI, which was then added to the model as a ninth predictor variable. Brier scores and c-indices were compared for the models with and without the SVI.ResultsThe analysis included 31,222 patients from five hospitals. Brier scores were identical for eight outcomes and improved by only one to two points in the fourth decimal place for four outcomes with addition of the SVI. Similarly, c-indices were not significantly different (p values ranged from 0.15 to 0.96). Of note, the SVI was associated with most of the eight SURPAS predictor variables, suggesting that SURPAS may already indirectly capture this important risk factor.ConclusionThe eight-variable SURPAS prediction model was not significantly improved by adding the SVI, showing that this parsimonious tool functions well without including a measure of social vulnerability.Copyright © 2022 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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