title: Development of a sleeve gastrectomy risk calculator.
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is rapidly gaining popularity. Estimating the risk of postoperative adverse events can improve surgical decision-making and informed patient consent. The objective of this study was to develop and validate a risk prediction model for early postoperative morbidity and mortality after LSG.
  
  
  METHODS
  Cases of primary LSG in the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) data set at year 2012 (n = 5871) and 2011 (n = 3130) were identified to develop and examine the validity of model. The composite primary outcome was defined as presence of any of 14 serious adverse events within the 30-days after LSG. Multiple logistic regression analysis was performed and a risk calculator was created to predict the primary outcome.
  
  
  RESULTS
  Thirty-day postoperative mortality and composite adverse events rates of 5871 LSG cases were .05% and 2.4%, respectively. Of the 52 examined baseline variables, the final model contained history of congestive heart failure (odds ratio [OR] 6.23; 95% CI 1.25-31.07), chronic steroid use (OR 5.00; 95% CI 2.06-12.15), male sex (OR 1.68; 95% CI 1.03-2.72), diabetes (OR 1.62; 95% CI 1.07-2.48), preoperative serum total bilirubin level (OR 1.57; 95% CI 1.11-2.22), body mass index (OR 1.03; 95% CI 1.01-1.05), and preoperative hematocrit level (OR .95; 95% CI .89-1.00). The risk model was then validated with the 2011 data set and was used to create an online risk calculator with a relatively good accuracy (c-statistic .682).
  
  
  CONCLUSIONS
  This risk assessment scoring system, which specifically estimates serious adverse events after LSG, can contribute to surgical decision-making, informed patient consent, and prediction of surgical risk for patients and referring physicians.
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ali
authors.initials: A
authors.lastname: Aminian
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Maryam
authors.initials: M
authors.lastname: Sharafkhah
authors.affiliation: Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: schauep@ccf.org.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009017:Morbidity / Q000639:trends; D009767:Obesity, Morbid / Q000601:surgery*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Bariatric; Calculator; Complication; Morbid obesity; Morbidity; Mortality; NSQIP; Risk; Sleeve gastrectomy