Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery
Abstract Background Clinical determination of patients at high risk of poor surgical outcomes is complex and may be supported by clinical tools to summarize the patient’s own personalized electronic health record (EHR) history and vitals data through predictive risk models. Since prior models were n...
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BMC
2025-01-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-024-02880-4 |
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| author | Edward N. Yap Jie Huang Joshua Chiu Robert W. Chang Bradley Cohn Judith C. F. Hwang Mary Reed |
| author_facet | Edward N. Yap Jie Huang Joshua Chiu Robert W. Chang Bradley Cohn Judith C. F. Hwang Mary Reed |
| author_sort | Edward N. Yap |
| collection | DOAJ |
| description | Abstract Background Clinical determination of patients at high risk of poor surgical outcomes is complex and may be supported by clinical tools to summarize the patient’s own personalized electronic health record (EHR) history and vitals data through predictive risk models. Since prior models were not readily available for EHR-integration, our objective was to develop and validate a risk stratification tool, named the Assessment of Geriatric Emergency Surgery (AGES) score, predicting risk of 30-day major postoperative complications in geriatric patients under consideration for urgent and emergency surgery using pre-surgical existing electronic health record (EHR) data. Methods Patients 65-years and older undergoing urgent or emergency non-cardiac surgery within 21 hospitals 2017–2021 were used to develop the model (randomly split: 80% training, 20% test). The primary outcome was a 30-day composite outcome including several postoperative major complications and mortality; secondary outcomes included common individual complications included in the primary composite outcome (sepsis, progressive renal insufficiency or renal failure, and mortality). Patients’ EHR-based clinical history, vital signs, labs, and demographics were included in logistic regression, LASSO, decision tree, Random Forest, and XGBoost models. Area under the receiver operating characteristics curve (AUCROC) was used to compare model performance. Results Overall, 66,262 patients (median [IQR] age 78 [(70.9–84.0], female 53.9%, White race 68.5%) received urgent or emergency non-cardiac surgery (25.7% orthopedic cases, 21.9% general surgery cases). AUCROC ranged from 0.655 (Decision Tree) – 0.804 (XGBoost) for the primary composite outcome. XGBoost AUCROC was 0.823, 0.781, and 0.839 in predicting outcomes of sepsis, progressive renal insufficiency or renal failure, and mortality, respectively. Conclusions We developed a model to accurately predict major postoperative complications in geriatric patients undergoing urgent or emergency surgery using the patient’s own existing EHR data. EHR implementation of this model could efficiently support clinicians’ surgical risk assessment and perioperative decision-making discussions in this vulnerable patient population. |
| format | Article |
| id | doaj-art-4b87bf607e6545af813d2ee59d0dd78e |
| institution | Kabale University |
| issn | 1471-2253 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj-art-4b87bf607e6545af813d2ee59d0dd78e2025-02-02T12:39:57ZengBMCBMC Anesthesiology1471-22532025-01-012511910.1186/s12871-024-02880-4Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgeryEdward N. Yap0Jie Huang1Joshua Chiu2Robert W. Chang3Bradley Cohn4Judith C. F. Hwang5Mary Reed6Department of Anesthesia, The Permanente Medical Group, Kaiser Permanente South San FranciscoKaiser Permanente Division of ResearchDepartment of Anesthesia and Perioperative Care, University of California San FranciscoKaiser Permanente Division of ResearchDepartment of Anesthesia, The Permanente Medical GroupDepartment of Anesthesia, The Permanente Medical GroupKaiser Permanente Division of ResearchAbstract Background Clinical determination of patients at high risk of poor surgical outcomes is complex and may be supported by clinical tools to summarize the patient’s own personalized electronic health record (EHR) history and vitals data through predictive risk models. Since prior models were not readily available for EHR-integration, our objective was to develop and validate a risk stratification tool, named the Assessment of Geriatric Emergency Surgery (AGES) score, predicting risk of 30-day major postoperative complications in geriatric patients under consideration for urgent and emergency surgery using pre-surgical existing electronic health record (EHR) data. Methods Patients 65-years and older undergoing urgent or emergency non-cardiac surgery within 21 hospitals 2017–2021 were used to develop the model (randomly split: 80% training, 20% test). The primary outcome was a 30-day composite outcome including several postoperative major complications and mortality; secondary outcomes included common individual complications included in the primary composite outcome (sepsis, progressive renal insufficiency or renal failure, and mortality). Patients’ EHR-based clinical history, vital signs, labs, and demographics were included in logistic regression, LASSO, decision tree, Random Forest, and XGBoost models. Area under the receiver operating characteristics curve (AUCROC) was used to compare model performance. Results Overall, 66,262 patients (median [IQR] age 78 [(70.9–84.0], female 53.9%, White race 68.5%) received urgent or emergency non-cardiac surgery (25.7% orthopedic cases, 21.9% general surgery cases). AUCROC ranged from 0.655 (Decision Tree) – 0.804 (XGBoost) for the primary composite outcome. XGBoost AUCROC was 0.823, 0.781, and 0.839 in predicting outcomes of sepsis, progressive renal insufficiency or renal failure, and mortality, respectively. Conclusions We developed a model to accurately predict major postoperative complications in geriatric patients undergoing urgent or emergency surgery using the patient’s own existing EHR data. EHR implementation of this model could efficiently support clinicians’ surgical risk assessment and perioperative decision-making discussions in this vulnerable patient population.https://doi.org/10.1186/s12871-024-02880-4Risk prediction modelGeriatric surgeryEmergency surgery |
| spellingShingle | Edward N. Yap Jie Huang Joshua Chiu Robert W. Chang Bradley Cohn Judith C. F. Hwang Mary Reed Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery BMC Anesthesiology Risk prediction model Geriatric surgery Emergency surgery |
| title | Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery |
| title_full | Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery |
| title_fullStr | Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery |
| title_full_unstemmed | Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery |
| title_short | Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery |
| title_sort | development and validation of an ehr based risk prediction model for geriatric patients undergoing urgent and emergency surgery |
| topic | Risk prediction model Geriatric surgery Emergency surgery |
| url | https://doi.org/10.1186/s12871-024-02880-4 |
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