Surgical Risk Preoperative Assessment System

Surgical procedures carry some risk of adverse outcomes ranging from an easily-treated superficial wound infection to death. Despite a significant decrease in perioperative mortality and morbidity rates over the last 20 years, adverse surgical outcomes remain a concern to patients, their families, and surgical teams. Costs of hospitalizations for patients experiencing a complication are up to five times greater than those of patients without a complication. Also, the occurrence of a complication is strongly associated with decreased long-term survival beyond 30 days following major surgery. Health information technology (IT) can be used to better inform patients and their families of risk estimates and improve patient-centered care for individuals requiring surgery.

This project designed, developed, implemented, and evaluated an IT-based, preoperative surgical risk assessment and decision support tool. This patient-centric tool, the SUrgical Risk Preoperative Assessment System (SURPAS), was designed to improve surgical healthcare quality with real-time preoperative surgical risk estimates using sets of risk factors and outcomes drawn from electronic health records (EHRs). The project hypothesized that providing quantitative risk estimates to the surgical team, patient, and relevant hospital personnel would lead to improved operative outcomes and reduced costs.

The specific aims of the project were as follows:

• Apply an existing theoretical model of health IT usage behavior to engage stakeholders. 
• Develop, implement on a limited basis, and refine SURPAS at the University of Colorado Hospital. 
• Use information generated during the present proposal to develop a dissemination and implementation proposal. 

Researchers engaged stakeholders, including hospital administrative leadership, surgical providers, and patients, through focus groups and interviews to identify facilitators and barriers to SURPAS implementation. They used this information to iteratively optimize the design of SURPAS in the local EHR and implemented the tool in a pilot study. The tool improved patients’ understanding and comfort with planned operations, as well as the shared decision-making process in the preoperative care environment. The findings from the pilot study are guiding the dissemination of SURPAS, which will facilitate routine, standardized preoperative risk assessment.