114. A Nationally Validated Novel Risk Assessment Score for Prediction of Unplanned Reoperations and Readmissions in Hand Surgery

Abstract

PURPOSE: Risk predictors are an emerging tool as the need for granular, individualized risk estimation remains necessary for informed patient counseling and clinical decision making. Existing comorbidity-driven risk indices have had varied success in accurately predicting risk in hand surgery. This study provides a novel risk score for reliably predicting reoperations and readmissions in hand surgery. METHODS: Hand surgeries from the National Surgical Quality Improvement Program (NSQIP) 2012 to 2020 database were identified by Current Procedural Terminology (CPT) codes. Independent predictors of 30-day unplanned reoperation and readmission were identified using multivariable logistic regression with backward variable selection on the testing sample (2012-2019). Subsequently, the predictors were weighted according to β-coefficients to generate an integer-based Novel Risk Score (NRS) predictive of reoperation and readmission. The NRS was then validated on 1000 bootstrapped replications of the original sample, and again tested on NSQIP patients who had undergone hand surgery in 2020. The NRS was compared to the modified frailty index (mFI-5) and the modified Charlson Comorbidity Index (mCCI) with receiver operating characteristics (ROC) analysis. RESULTS: 83,409 hand surgeries were identified in the modeling cohort. Reoperations and readmissions occurred 1.1% and 1.3% of the time, respectively. Independent risk factors included male gender, inpatient status, smoking, dialysis dependence, transfusion within 72 hours of surgery, wound classification, ASA Class, diabetes mellitus, CHF, sepsis or septic shock, emergent case, and long initial operative time (all P < 0.05). ROC analysis of the testing (2020) cohort rendered an area under the curve of 0.730, which demonstrates the accuracy of this prediction model. The mFI-5 and mCCI rendered AUCs of 0.580 and 0.585, respectively. CONCLUSION: We present a validated risk stratification tool for unplanned reoperations and readmissions following hand surgery that outperforms the mFI-5 and mCCI. Future studies should determine if implementation of this NRS optimizes safety and reduces reoperation and readmission rates in hand surgery patients.