title: An Online Tool for Global Benchmarking of Risk-Adjusted Surgical Outcomes.
abstract: Increasing evidence demonstrates significant variation in adverse outcomes following surgery between countries. In order to better quantify these variations, we hypothesize that freely available online risk calculators can be used as a tool to generate global benchmarking of risk-adjusted surgical outcomes.
  
  
  
  This is a prospective cohort study conducted at an academic teaching hospital in South Africa (GSH). Consecutive adult patients undergoing major general or vascular surgery who met the ACS-NSQIP inclusion criteria for a 3-month period were included. Data variables required by the ACS risk calculator were prospectively collected, and patients were followed for 30 days post-surgery for the occurrence of endpoints. Calculating observed-to-expected ratios for ten outcome measures of interest generated risk-adjusted outcomes benchmarked against the ACS-NSQIP consortium.
  
  
  
  A total of 373 major general and vascular surgery procedures met the inclusion criteria. The GSH operative cohort varied significantly compared to the 2012 ACS-NSQIP database. The risk-adjusted O/E ratios were significant for any complication O/E 1.91 (95 % CI 1.57-2.31), surgical site infections O/E 4.76 (95 % CI 3.71-6.01), renal failure O/E 3.29 (95 % CI 1.50-6.24), death O/E 3.43 (95 % CI 2.19-5.11), and total length of stay (LOS) O/E 3.43 (95 % CI 2.19-5.11).
  
  
  
  Freely available online risk calculators can be utilized as tools for global benchmarking of risk-adjusted surgical outcomes.
authors.affiliation: Codman Center for Clinical Effectiveness in Surgery, Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA. spnric004@myuct.ac.za.|Department of Surgery, University of Cape Town, 1101 Rondebosch Oaks Albion Road Rondebosch, Cape Town, 7700, South Africa. spnric004@myuct.ac.za.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Spence
authors.affiliation: Codman Center for Clinical Effectiveness in Surgery, Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.affiliation: Department of Surgery, University of Cape Town, 1101 Rondebosch Oaks Albion Road Rondebosch, Cape Town, 7700, South Africa.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Chu
authors.affiliation: Department of Surgery, University of Cape Town, 1101 Rondebosch Oaks Albion Road Rondebosch, Cape Town, 7700, South Africa.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Panieri
authors.affiliation: Codman Center for Clinical Effectiveness in Surgery, Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Mueller
authors.affiliation: Codman Center for Clinical Effectiveness in Surgery, Department of General Surgery, Massachusetts General Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Hutter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020379:Risk Adjustment; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D055815:Young Adult