Comparison of National Surgical Quality Improvement Program Surgical Risk Calculator and Trauma and Injury Severity Score Risk Assessment Tools in Predicting Outcomes in High-Risk Operative Trauma Patients

Jeffrey Santos; Catherine M Kuza; Xi Luo; Babatunde Ogunnaike; M Iqbal Ahmed; Emily Melikman; Tiffany Moon; Thomas Shoultz; Anne Feeler; Roman Dudaryk; Jose Navas; Georgia Vasileiou; D Dante Yeh; Kazuhide Matsushima; Matthew Forestiere; Tiffany Lian; Areg Grigorian; Joni Ricks-Oddie; Jeffry Nahmias

doi:10.1177/00031348231175488

Comparison of National Surgical Quality Improvement Program Surgical Risk Calculator and Trauma and Injury Severity Score Risk Assessment Tools in Predicting Outcomes in High-Risk Operative Trauma Patients

Am Surg. 2023 Oct;89(10):4038-4044. doi: 10.1177/00031348231175488. Epub 2023 May 12.

Authors

Jeffrey Santos¹, Catherine M Kuza², Xi Luo³, Babatunde Ogunnaike³, M Iqbal Ahmed³, Emily Melikman³, Tiffany Moon³, Thomas Shoultz⁴, Anne Feeler⁴, Roman Dudaryk⁵, Jose Navas⁵, Georgia Vasileiou⁶, D Dante Yeh⁶, Kazuhide Matsushima⁷, Matthew Forestiere⁷, Tiffany Lian⁷, Areg Grigorian¹, Joni Ricks-Oddie⁸, Jeffry Nahmias¹

Affiliations

¹ Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA, USA.
² Department of Anesthesiology, University of Southern California, Los Angeles, CA, USA.
³ Department of Anesthesiology, University of Texas Southwestern, Dallas, TX, USA.
⁴ Division of Burns, Trauma and Critical Care, University of Texas Southwestern, Dallas, TX, USA.
⁵ Department of Anesthesiology and Pain Management, University of Miami, Miami, FL, USA.
⁶ Department of Surgery, University of Miami, Miami, FL, USA.
⁷ Department of Surgery, University of Southern California, Los Angeles, CA, USA.
⁸ Institute for Clinical and Translation Sciences and Center for Statistical Consulting, University of California, Irvine, Orange, CA, USA.

PMID: 37173283
DOI: 10.1177/00031348231175488

Abstract

Background: The Trauma and Injury Severity Score (TRISS) uses anatomic/physiologic variables to predict outcomes. The National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP-SRC) includes functional status and comorbidities. It is unclear which of these tools is superior for high-risk trauma patients (American Society of Anesthesiologists Physical Status (ASA-PS) class IV or V). This study compares risk prediction of TRISS and NSQIP-SRC for mortality, length of stay (LOS), and complications for high-risk operative trauma patients.

Methods: This is a prospective study of high-risk (ASA-PS IV or V) trauma patients (≥18 years-old) undergoing surgery at 4 trauma centers. We compared TRISS vs NSQIP-SRC vs NSQIP-SRC + TRISS for ability to predict mortality, LOS, and complications using linear, logistic, and negative binomial regression.

Results: Of 284 patients, 48 (16.9%) died. The median LOS was 16 days and number of complications was 1. TRISS + NSQIP-SRC best predicted mortality (AUROC: .877 vs .723 vs .843, P = .0018) and number of complications (pseudo-R²/median error (ME) 5.26%/1.15 vs 3.39%/1.33 vs 2.07%/1.41, P < .001) compared to NSQIP-SRC or TRISS, but there was no difference between TRISS + NSQIP-SRC and NSQIP-SRC with LOS prediction (P = .43).

Discussion: For high-risk operative trauma patients, TRISS + NSQIP-SRC performed better at predicting mortality and number of complications compared to NSQIP-SRC or TRISS alone but similar to NSQIP-SRC alone for LOS. Thus, future risk prediction and comparisons across trauma centers for high-risk operative trauma patients should include a combination of anatomic/physiologic data, comorbidities, and functional status.

Keywords: National Surgical Quality Improvement Program Surgical Risk Calculator; Trauma and Injury Severity Score; complications; high-risk; length of stay; mortality.

MeSH terms

Adolescent
Humans
Injury Severity Score
Postoperative Complications / epidemiology
Prospective Studies
Quality Improvement*
Risk Assessment
Surgical Wound*