Abstract
BackgroundRisk assessment is essential to informed decision making in surgery. Preoperative use of the Surgical Risk Preoperative Assessment System (SURPAS) providing individualized risk assessment, may enhance informed consent. We assessed patient and provider perceptions of SURPAS as a risk assessment tool.MethodsA convergent mixed-methods study assessed SURPAS’s trial implementation, concurrently collecting quantitative and qualitative data, separately analyzing it, and integrating the results. Patients and providers were surveyed and interviewed on their opinion of how SURPAS impacted the preoperative encounter. Relationships between patient risk and patient and provider assessment of SURPAS were examined.ResultsA total of 197 patients were provided their SURPAS postoperative risk estimates in nine surgeon’s clinics. Of the total patients, 98.8% reported they understood their surgical risks very or quite well after exposure to SURPAS; 92.7% reported SURPAS was very helpful or helpful. Providers shared that 83.4% of the time they reported SURPAS was very or somewhat helpful; 44.7% of the time the providers reported it changed their interaction with the patient and this change was beneficial 94.3% of the time. As patient risk increased, providers reported that SURPAS was increasingly helpful (p < 0.0001).ConclusionsPatients and providers reported the use of SURPAS helpful and informative during the preoperative risk assessment of patients, thus improving the surgical decision making process. Patients thought that SURPAS was helpful regardless of their risk level, whereas providers thought that SURPAS was more helpful in higher risk patients.
Highlights
Risk assessment is essential to informed decision making in surgery
We initiated a trial implementation of Surgical Risk Preoperative Assessment System (SURPAS) in elective surgical patients across a broad range of surgical clinics. We evaluated this trial implementation assessing patient and provider perceptions of SURPAS as a risk assessment tool utilizing a mixed methodology to assess the utilization of SURPAS
We interviewed providers who implemented SURPAS and a convenience sampling of patients who experienced SURPAS utilizing specific interview guides during their pre-surgical risk assessment to obtain their opinions of the tool and how it was used in their clinical encounter
Summary
Risk assessment is essential to informed decision making in surgery. Preoperative use of the Surgical Risk Preoperative Assessment System (SURPAS) providing individualized risk assessment, may enhance informed consent. Formal risk assessment tools exist, such as the American College of Surgeons’ (ACS) Surgical Risk Calculator and the Veterans Affairs Surgical Quality Improvement Program (VASQIP) Risk Calculator. These and other tools require considerable time to use and are not integrated into clinical workflow or electronic health records (EHR) [13]. The ACS Surgical Risk Calculator has limitations regarding accuracy of risk estimates for higher risk patients. These issues are addressed by the Surgical Risk Preoperative Assessment System (SURPAS) [14,15,16,17]
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