title: Risk of discharge to postacute care: a patient-centered outcome for the american college of surgeons national surgical quality improvement program surgical risk calculator.
abstract: OBJECTIVE
  Individualized risk prediction tools have an important role as decision aids for use by patients and surgeons before surgery. Patient-centered outcomes should be incorporated into such tools to widen their appeal and improve their usability.
  
  
  OBJECTIVE
  To develop a patient-centered outcome for the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator, a web-based, individualized risk prediction tool.
  
  
  METHODS
  Retrospective cohort study using data from the ACS NSQIP, a national clinical data registry. A total of 973 211 patients from July 2010 to June 2012, encompassing 392 hospitals, were used in this analysis.
  
  
  METHODS
  Risk of discharge to a postacute care setting.
  
  
  RESULTS
  The overall rate of discharge to postacute care was 8.8%. Significant predictors of discharge to postacute care included being 85 years or older (odds ratio [OR] = 9.17; 95% CI, 8.84-9.50), the presence of septic shock (OR = 2.43; 95% CI, 2.20-2.69) or ventilator dependence (OR = 2.81; 95% CI, 2.56-3.09) preoperatively, American Society of Anesthesiologists class of 4 or 5 (OR = 3.59; 95% CI, 3.46-3.71), and totally dependent functional status (OR = 2.27; 95% CI, 2.11-2.44). The final model predicted risk of discharge to postacute care with excellent accuracy (C statistic = 0.924) and calibration (Brier score = 0.05).
  
  
  CONCLUSIONS
  Individualized risk of discharge to postacute care can be predicted with excellent accuracy. This outcome will be incorporated into the ACS NSQIP Surgical Risk Calculator.
authors: Department of Surgery, Henry Ford Hospital, Detroit, Michigan2Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
authors: Sanjay
authors: S
authors: Mohanty
authors: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
authors: Yaoming
authors: Y
authors: Liu
authors: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
authors: Jennifer L
authors: JL
authors: Paruch
authors: Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors: Thomas E
authors: TE
authors: Kmiecik
authors: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
authors: Mark E
authors: ME
authors: Cohen
authors: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois4Department of Surgery, University of California, Los Angeles5VA Greater Los Angeles Healthcare System, Los Angeles, California.
authors: Clifford Y
authors: CY
authors: Ko
authors: Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois3Surgical Outcomes and Quality Improvement Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors: Karl Y
authors: KY
authors: Bilimoria
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011184:Postoperative Period; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013514:Surgical Procedures, Operative; D014481:United States