Development of a sleeve gastrectomy risk calculator

• DOI: 10.1016/j.soard.2014.12.012
• Publication Date: 2014-12-20T08:14:35Z
• Authors: Ali Aminian; Stacy A. Brethauer; Maryam Sharafkhah; Philip R. Schauer
• Keywords: Adult; Male; Reproducibility of Results; Risk Assessment; United States; Obesity, Morbid; 3. Good health; Survival Rate; 03 medical and health sciences; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Gastrectomy; Risk Factors; Outcome Assessment, Health Care; Odds Ratio; Humans; Female; Laparoscopy; Morbidity; Retrospective Studies

Laparoscopic sleeve gastrectomy (LSG) is rapidly gaining popularity. Estimating the risk of postoperative adverse events can improve surgical decision-making and informed patient consent. The objective of this study was to develop and validate a risk prediction model for early postoperative morbidity and mortality after LSG.Cases of primary LSG in the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) data set at year 2012 (n = 5871) and 2011 (n = 3130) were identified to develop and examine the validity of model. The composite primary outcome was defined as presence of any of 14 serious adverse events within the 30-days after LSG. Multiple logistic regression analysis was performed and a risk calculator was created to predict the primary outcome.Thirty-day postoperative mortality and composite adverse events rates of 5871 LSG cases were .05% and 2.4%, respectively. Of the 52 examined baseline variables, the final model contained history of congestive heart failure (odds ratio [OR] 6.23; 95% CI 1.25-31.07), chronic steroid use (OR 5.00; 95% CI 2.06-12.15), male sex (OR 1.68; 95% CI 1.03-2.72), diabetes (OR 1.62; 95% CI 1.07-2.48), preoperative serum total bilirubin level (OR 1.57; 95% CI 1.11-2.22), body mass index (OR 1.03; 95% CI 1.01-1.05), and preoperative hematocrit level (OR .95; 95% CI .89-1.00). The risk model was then validated with the 2011 data set and was used to create an online risk calculator with a relatively good accuracy (c-statistic .682).This risk assessment scoring system, which specifically estimates serious adverse events after LSG, can contribute to surgical decision-making, informed patient consent, and prediction of surgical risk for patients and referring physicians.