• Jayson S Marwaha, Brendin R Beaulieu-Jones, Margaret Berrigan, William Yuan, Stephen R Odom, Charles H Cook, Benjamin B Scott, Alok Gupta, Charles S Parsons, Anupamaa J Seshadri, and Gabriel A Brat.
• From the Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA (Marwaha, Beaulieu-Jones, Berrigan, Odom, Cook, Scott, Gupta, Parsons, Seshadri, Brat).
• J. Am. Coll. Surg. 2023 Jun 1; 236 (6): 109311031093-1103.

BackgroundSurgical risk prediction models traditionally use patient attributes and measures of physiology to generate predictions about postoperative outcomes. However, the surgeon's assessment of the patient may be a valuable predictor, given the surgeon's ability to detect and incorporate factors that existing models cannot capture. We compare the predictive utility of surgeon intuition and a risk calculator derived from the American College of Surgeons (ACS) NSQIP.Study DesignFrom January 10, 2021 to January 9, 2022, surgeons were surveyed immediately before performing surgery to assess their perception of a patient's risk of developing any postoperative complication. Clinical data were abstracted from ACS NSQIP. Both sources of data were independently used to build models to predict the likelihood of a patient experiencing any 30-day postoperative complication as defined by ACS NSQIP.ResultsPreoperative surgeon assessment was obtained for 216 patients. NSQIP data were available for 9,182 patients who underwent general surgery (January 1, 2017 to January 9, 2022). A binomial regression model trained on clinical data alone had an area under the receiver operating characteristic curve (AUC) of 0.83 (95% CI 0.80 to 0.85) in predicting any complication. A model trained on only preoperative surgeon intuition had an AUC of 0.70 (95% CI 0.63 to 0.78). A model trained on surgeon intuition and a subset of clinical predictors had an AUC of 0.83 (95% CI 0.77 to 0.89).ConclusionsPreoperative surgeon intuition alone is an independent predictor of patient outcomes; however, a risk calculator derived from ACS NSQIP is a more robust predictor of postoperative complication. Combining intuition and clinical data did not strengthen prediction.Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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