Development and Validation of an Electronic Postoperative Morbidity Score.
Bowen, Jessica L
Furness, Rachel C
Gilder, Fay J
Anesthesia and analgesia
Wolters Kluwer Health
MetadataShow full item record
Stubbs, D., Bowen, J. L., Furness, R. C., Gilder, F. J., Romero-Ortuno, R., Biram, R., Menon, D., & et al. (2019). Development and Validation of an Electronic Postoperative Morbidity Score.. Anesthesia and analgesia, 129 (4), 935-942. https://doi.org/10.1213/ane.0000000000003953
Background: Electronic health records (EHR) are being adopted due to numerous potential benefits. This requires the development of objective metrics to characterize morbidity, comparable to studies performed in centers without an EHR. We outline development of an electronic version (E-POMS) of the postoperative morbidity score (POMS) for integration into our EHR. Methods: 207 frail patients who underwent elective surgery were reviewed. We retrospectively defined POMS morbidity on postoperative day 3 (D3). We also recorded potential electronic surrogates for morbidities that could not be easily extracted in an objective format. We compared discriminative capability (area under the receiver operator curve - AUC) for patients having prolonged length of stay (pLOS) or complex discharge requirements (CD). Results: 138 patients (67%) had morbidity in at least one POMS domain. Initial electronic surrogates were overly sensitive, identifying 173 patients (84%) as having morbidity. We refined our definitions using backwards logistic regression against ‘gold-standard’ POMS. The final E-POMS differed from the initial version in its definition of cardiac and neurological morbidity. There was no significant difference in discriminative capability between E-POMS and POMS for either outcome (AUC 0.66 v 0.66 for CD, AUC 0.66 v 0.67 for pLOS, for both). Patients with POMS or E-POMS defined morbidity on D3 had increased risk of prolonged length of stay ( for both) Conclusions: We present a variant of POMS based on objective electronic metrics. Discriminative performance appeared comparable to gold-standard definitions for discharge outcomes. E-POMS may allow characterization of morbidity within our EHR but further work is required to assess external validity.
Humans, Postoperative Complications, Treatment Outcome, Length of Stay, Risk Assessment, Risk Factors, Retrospective Studies, Reproducibility of Results, Predictive Value of Tests, Age Factors, Decision Support Techniques, Time Factors, Aged, Aged, 80 and over, Frail Elderly, Female, Male, Electronic Health Records, Elective Surgical Procedures, Frailty
Wellcome Trust (204017/Z/16/Z)
External DOI: https://doi.org/10.1213/ane.0000000000003953
This record's URL: https://www.repository.cam.ac.uk/handle/1810/286687