Patient-Centered outcome spectrum: An evidence-based framework to aid in shared decision-making

Objective: Our objective was to develop an alternate construct for reporting anticipated outcomes after emergency general surgery (EGS) that presents risk in terms of a composite measure. Background: Currently available prediction tools generate risk outputs for discrete as opposed to composite measures of postoperative outcomes. A construct to synthesize multiple discrete estimates into a global understanding of a patient’s likely postoperative health status is lacking and could augment shared decision-making conversations. Methods: Using the 2012 to 2014 American College of Surgeons National Surgical Quality Improvement Program Participant Use File, we developed the Patient-Centered Outcomes Spectrum (PCOS) for patients 65 years old who underwent an EGS operation. The PCOS defines 3 exclusive types of global outcomes (good, intermediate, and bad outcomes) and allows patients to be prospectively stratified by both their EGS diagnosis and preoperative surgical risk profile. Results: Of the patients in our study population, 13,330 (46.4%) experienced a 30-day postoperative course considered a good outcome. Conversely, 3791 (13.2%) of study patients experienced a bad outcome. The remainder of patients (11,617; 40.4%) were classified as experiencing an intermediate outcome. The incidence of good, intermediate, and bad outcomes was 69.7%, 28.2%, and 2.1% for low-risk patients, and 22.0%, 48.9%, and 29.1% for high-risk patients. Diagnosis-specific PCOS constructs are also provided. Conclusions: Consistent with the goals of shared decision-making, the PCOS provides an evidence-based construct based upon a composite outcome measure for patients and providers as they weigh the risks of undergoing EGS.