Report of a Quality Improvement Program for Reducing Postoperative Complications by Using a Surgical Risk Calculator in a Cohort of General Surgery Patients

  • Elisa M. Müller
  • Eva Herrmann
  • Thomas Schmandra
  • Thomas F. Weigel
  • Ernst Hanisch
  • Alexander BuiaEmail author
Original Scientific Report



The study investigates whether postoperative complications in elective surgery can be reduced by using a risk calculator via raising the awareness of the surgeon in a preoperative briefing. Postoperative complications like wound infections or pneumonia result in a high burden for healthcare systems. Multiple quality improvement programs address this problem like the ACS NSQIP Surgical Risk Calculator® (SRC).


To determine whether the preoperative usage of the SRC could reduce inpatient postoperative complications, two groups of 832 patients each were compared using propensity score matching. The SRC was employed retrospectively in the period 2012/2013 in one group (“Retro”) and prospectively in the other group (“Prosp”) in the period 2014/2015. Actual inpatient postoperative complications were classified by SRC complication categories and compared with the Clavien–Dindo complication classification system (Dindo et al. in Ann Surg 240:205–213, 2004).


Comparing SRC “serious complication” and SRC “any complication,” a nonsignificant increase in the “Prosp”-group was apparent (serious complication: 6.6% vs. 8.5%, p = 0.164; any complication: 8.5% vs. 9.7%, p = 0.444).


Use of the SRC neither reduces inpatient postoperative complications nor the severity of complications. The calculations of the SRC rely on a 30-day postoperative follow-up. Poor sensitivity and medium specificity of the SRC showed that the SRC could not make accurate predictions in a short follow-up time averaging 6 days. Alternatively, since the observed complication rate was low in our study, in an environment of already highly implemented risk management tools, reductions in complications are not easily achieved.


Supplementary material

268_2020_5393_MOESM1_ESM.docx (50 kb)
Supplementary material 1 (DOCX 49 kb)


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Copyright information

© Société Internationale de Chirurgie 2020

Authors and Affiliations

  1. 1.Department of General, Visceral and Thoracic Surgery, Asklepios Klinik LangenAcademic Teaching Hospital Goethe-University FrankfurtLangenGermany
  2. 2.Department of Biostatistics and Mathematical ModelingGoethe-University FrankfurtFrankfurtGermany
  3. 3.Department of Vascular SurgeryRhön Klinik Bad Neustadt a. d. SaaleBad Neustadt an der SaaleGermany
  4. 4.Department of General and Visceral SurgeryHeilig-Geist-Hospital BingenBingen am RheinGermany

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