title: Development and validation of a bariatric surgery mortality risk calculator.
abstract: BACKGROUND
  While the epidemic of obesity continues to plague America, bariatric surgery is underused due to concerns for surgical risk among patients and referring physicians. A risk score estimating postoperative mortality (OS-MRS) exists, however, is limited by consideration of only 12 preoperative variables, failure to separate open and laparoscopic cases, a lack of robust statistical analyses, risk factors not being weighted, and being applicable to only gastric bypass surgery. The objective of this study was to develop a validated risk calculator for 30-day postoperative mortality after bariatric surgery.
  
  
  METHODS
  The National Surgical Quality Improvement Program (NSQIP) dataset (2006 to 2008) was used. Patients undergoing bariatric surgery for morbid obesity (n = 32,889) were divided into training (n = 21,891) and validation (n = 10,998) datasets. Multiple logistic regression analysis was performed on the training dataset. The model fit from the training dataset was maintained and was used to estimate mortality probabilities for all patients in the validation dataset.
  
  
  RESULTS
  Thirty-day mortality was 0.14%. Seven independent predictors of mortality were identified: peripheral vascular disease, dyspnea, previous percutaneous coronary intervention, age, body mass index, chronic corticosteroid use, and type of bariatric surgery. This risk model was subsequently validated. The model performance was very similar between the training and the validation datasets (c-statistics, 0.80 and 0.82, respectively). The high c-statistics indicate excellent predictive performance. The risk model was used to develop an interactive risk calculator.
  
  
  CONCLUSIONS
  This risk calculator has excellent predictive ability for mortality after bariatric procedures. It is anticipated that it will aid in surgical decision-making, informed patient consent, and in helping patients and referring physicians to assess the true bariatric surgical risk.
authors.affiliation: Department of Surgery, Creighton University, Omaha, NE 68131, USA.
authors.forename: Bala
authors.initials: B
authors.lastname: Ramanan
authors.forename: Prateek K
authors.initials: PK
authors.lastname: Gupta
authors.forename: Himani
authors.initials: H
authors.lastname: Gupta
authors.forename: Xiang
authors.initials: X
authors.lastname: Fang
authors.forename: R Armour
authors.initials: RA
authors.lastname: Forse
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000193:education / Q000401:mortality*; D002983:Clinical Competence; D004502:Education, Medical, Continuing / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States