Surgery plays a major role in helping to prevent death and chronic disability for patients suffering from traumatic injuries, cancers, cardiovascular disease, obstetrical complications, and many other emergency conditions.
Despite the positive impact the surgeries can have on a patient's health, the surgical procedures carry a significant risk. It is estimated that over 7 million people worldwide suffer complications following surgery, and one million of them die as a result.
Even the most minor procedures carry some degree of risk. Patients could develop an infection, they may have an allergic reaction to one of the prescribed medications, or they may have a condition that could affect the surgery outcome or their recovery.
Many risk models are widely applied in the assessment of the relative impact of specific risk factors on surgical outcomes.
These risk models enable surgeons to not only select the ideal treatment option for a specific patient but also to counsel their patients accordingly.
The initial focus of surgery risk models was on the pre-operative prediction of mortality. It later expanded to predicting a major morbidity, which is more common than mortality and important method of determining a surgical outcome.
Many of these risk models are available as mobile apps, as well as web-based tools that can be accessed on smartphones and tablets.
Here, we listed some of the best resources to help calculate the surgery risk.
Clearing patients for surgery, i.e. deciding whether or not a patient is "safe" to proceed to the operating room, also known as pre-operative evaluation is a common practice in primary care, internal medicine, and anesthesiology.
There are many evidence-based guidelines made to assist providers in making this complex decision, which rarely provide the calculations of the patient's mortality risk.
Surgical Outcome Risk Tool (SORT) app was developed with a goal to help members of surgical teams predict the patient's 30-day mortality from surgery, based on a number of variables including the type of surgery, surgery severity, physical status of the patient, age of the patient, and more.
The app is available for free on Android and iOS.
PreOp Eval App
PreOp Eval app is a similar tool developed by Dr. Joshua Steinberg to provide guidance to the providers who evaluate and prepare adult patients for non-cardiac surgery.
The app is based on several guidelines, including those from the American College of Cardiology, the European Society of Anaesthesiology, the American Society of Anesthesiologists, the American College of Chest Physicians. All guidelines are referenced throughout the app.
The PreOp Eval app contains 1 algorithm and 3 resources, including the cardiac evaluation algorithm, guidance on starting and stopping key medications in the perioperative period, guidance on the timing of surgery after cardiac events, and guidance on preoperative testing.
The app also contains a review of preoperative evaluation provided mainly for medical students and residents.
The PreOp Eval app is available for free on iOS platform only.
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Adult Cardiac Surgery Risk App
Of all surgical procedures, open heart surgery perhaps carries the biggest risks.
The Adult Cardiac Surgery Risk app is designed to estimate the risk of morbidity and mortality following the most common types of open heart surgery, including coronary bypass surgery, aortic and mitral valve surgery, and combined valve-bypass surgery. The calculator within the app is based on the most recently available data submitted by surgeons throughout the United States.
The Adult Cardiac Surgery Risk app could be used as a tool to guide discussions with patients, families, and health care providers regarding the potential outcomes after open heart surgery.
The app is available on iOS for $0.99.
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Heart Surgery Risk App
Unlike the previous app, the Heart Surgery Risk app focuses on Coronary Artery Bypass Graft Surgery (CABG), which is a commonly performed procedure used to improve symptoms of angina, prevent major heart attacks, and, in some cases, to prolong lifespan.
The CABG surgery is relatively safe, however, there are potential risks of complications and death during or shortly after CABG surgery.
The Heart Risk Surgery app uses the calculator based on data from the Society of Thoracic Surgeons National Database and the Online Risk Calculator to provide patients and their families with estimates of what the chances for complications or death are for a patient who is considering CABG surgery.
The app is available for free on iOS.
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Bariatric or "weight loss" surgeries are performed to cause weight loss by restricting the amount of food the stomach can hold (gastric restriction), causing malabsorption of nutrients, or by a combination of both.
The most common bariatric surgery procedures are a gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch.
Most of them are performed using minimally invasive techniques, i.e. laparoscopic surgery, and carrying a risk, which is minimal, but still present.
These risks may include congestive heart failure, chronic steroid use, male gender, diabetes, high BMI, elevated preoperative serum bilirubin level, and more.
The team of researchers from Cleveland Clinic has created the Bariatric Surgery Calculator app which includes three calculators, or more precisely two risk calculators and one scoring system, including a sleeve gastrectomy risk calculator, a risk calculator for a post-discharge venous thromboembolism (VTE) - the most common cause of mortality after bariatric surgery, and a scoring system for evidence-based selection between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) surgeries.
The app is available for free on Android and iOS.
Clinical Calculator Apps
The popular clinical calculator apps such as Calculate by QxMD or MDCalc can be also used to estimate the surgery risk.
These apps contain several calculators and risk scores that can help medical providers to reduce and predict preoperative and postoperative risks and complications, such as ACC/AHA Perioperative Cardiac Evaluation, POSSUM for Operative Morbidity and Mortality Risk, Revised Cardiac Risk Index for Pre-Operative Risk, Gupta Perioperative Cardiac Risk Calculator, Postoperative Respiratory Failure Risk Calculator, and more.
Both Calculate by QxMD and MDCalc apps are available for free for Android and iOS devices.
Online Surgery Risk Calculators
Some of the surgery risk calculators are not available as mobile apps, yet web-based tools, but they nevertheless deserve to be mentioned in this article.
Surgical Risk Calculator developed by the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) is a web-based decision-making tool used by surgeons and their patients to accurately estimates the chance of a patient experiencing postoperative complications.
The Short-Term Risk Calculator made by the Society of Thoracic Surgeons (STS) allows providers to calculate a patient's risk of mortality and morbidities for the most commonly performed cardiac surgeries.
The Combined Assessment of Risk Encountered in Surgery (CARES) calculator was developed by a team of anesthesiologists at Singapore General Hospital to allows doctors to more accurately gauge the risks involved before undergoing surgery.
The calculator takes into account the nine health indicators, as well as demographics, lifestyle choices and healthcare systems unique to Singapore.
The score is then used to predict the patient's percentage risk of death within 30 days.
According to the tool's creators, the accuracy rate of the CARES calculator in predicting post-surgery mortality is equivalent to around 93 percent.