Development and validation of a bariatric surgery mortality risk calculator

Bala Ramanan, Prateek K. Gupta, Himani Gupta, Xiang Fang, R. Armour Forse

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background: While the epidemic of obesity continues to plague America, bariatric surgery is underused due to concerns for surgical risk among patients and referring physicians. A risk score estimating postoperative mortality (OS-MRS) exists, however, is limited by consideration of only 12 preoperative variables, failure to separate open and laparoscopic cases, a lack of robust statistical analyses, risk factors not being weighted, and being applicable to only gastric bypass surgery. The objective of this study was to develop a validated risk calculator for 30-day postoperative mortality after bariatric surgery. Study Design: The National Surgical Quality Improvement Program (NSQIP) dataset (2006 to 2008) was used. Patients undergoing bariatric surgery for morbid obesity (n = 32,889) were divided into training (n = 21,891) and validation (n = 10,998) datasets. Multiple logistic regression analysis was performed on the training dataset. The model fit from the training dataset was maintained and was used to estimate mortality probabilities for all patients in the validation dataset. Results: Thirty-day mortality was 0.14%. Seven independent predictors of mortality were identified: peripheral vascular disease, dyspnea, previous percutaneous coronary intervention, age, body mass index, chronic corticosteroid use, and type of bariatric surgery. This risk model was subsequently validated. The model performance was very similar between the training and the validation datasets (c-statistics, 0.80 and 0.82, respectively). The high c-statistics indicate excellent predictive performance. The risk model was used to develop an interactive risk calculator. Conclusions: This risk calculator has excellent predictive ability for mortality after bariatric procedures. It is anticipated that it will aid in surgical decision-making, informed patient consent, and in helping patients and referring physicians to assess the true bariatric surgical risk.

Original languageEnglish (US)
Pages (from-to)892-900
Number of pages9
JournalJournal of the American College of Surgeons
Volume214
Issue number6
DOIs
StatePublished - Jun 1 2012

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Bariatric Surgery
Mortality
Bariatrics
Physicians
Aptitude
Gastric Bypass
Plague
Morbid Obesity
Peripheral Vascular Diseases
Percutaneous Coronary Intervention
Quality Improvement
Informed Consent
Dyspnea
Datasets
Decision Making
Adrenal Cortex Hormones
Body Mass Index
Obesity
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

Development and validation of a bariatric surgery mortality risk calculator. / Ramanan, Bala; Gupta, Prateek K.; Gupta, Himani; Fang, Xiang; Forse, R. Armour.

In: Journal of the American College of Surgeons, Vol. 214, No. 6, 01.06.2012, p. 892-900.

Research output: Contribution to journalArticle

Ramanan, Bala ; Gupta, Prateek K. ; Gupta, Himani ; Fang, Xiang ; Forse, R. Armour. / Development and validation of a bariatric surgery mortality risk calculator. In: Journal of the American College of Surgeons. 2012 ; Vol. 214, No. 6. pp. 892-900.
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