• Sanjay Mohanty, Yaoming Liu, Jennifer L Paruch, Thomas E Kmiecik, Mark E Cohen, Clifford Y Ko, and Karl Y Bilimoria.
• Department of Surgery, Henry Ford Hospital, Detroit, Michigan2Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
• JAMA Surg. 2015 May 1;150(5):480-4.

ImportanceIndividualized risk prediction tools have an important role as decision aids for use by patients and surgeons before surgery. Patient-centered outcomes should be incorporated into such tools to widen their appeal and improve their usability.ObjectiveTo develop a patient-centered outcome for the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator, a web-based, individualized risk prediction tool.Design, Setting, And ParticipantsRetrospective cohort study using data from the ACS NSQIP, a national clinical data registry. A total of 973 211 patients from July 2010 to June 2012, encompassing 392 hospitals, were used in this analysis.Main Outcomes And MeasuresRisk of discharge to a postacute care setting.ResultsThe overall rate of discharge to postacute care was 8.8%. Significant predictors of discharge to postacute care included being 85 years or older (odds ratio [OR] = 9.17; 95% CI, 8.84-9.50), the presence of septic shock (OR = 2.43; 95% CI, 2.20-2.69) or ventilator dependence (OR = 2.81; 95% CI, 2.56-3.09) preoperatively, American Society of Anesthesiologists class of 4 or 5 (OR = 3.59; 95% CI, 3.46-3.71), and totally dependent functional status (OR = 2.27; 95% CI, 2.11-2.44). The final model predicted risk of discharge to postacute care with excellent accuracy (C statistic = 0.924) and calibration (Brier score = 0.05).Conclusions And RelevanceIndividualized risk of discharge to postacute care can be predicted with excellent accuracy. This outcome will be incorporated into the ACS NSQIP Surgical Risk Calculator.

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