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Clinical Validation of a Novel Risk Assessment Score for Prediction of Unplanned Reoperations and Readmissions in Hand Surgery
Olachi Oleru, Nargiz Seyidova
*, Jamie Frost, Niklas Koehne, Peter J. Taub
Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
Background: A recent study presented a novel risk stratification score for unplanned readmissions and reoperations in hand surgery (NRSa and NRSo, respectively). This risk score was validated using national surgical data and outperformed traditional risk indices. The present study aims to clinically validate this risk stratification tool.
Methods: Patients who underwent hand surgeries at the authors' institution from 2018 to 2020 were reviewed. Patients were included based on the list of CPT codes provided in the previous study. Data was collected specifically on the previously identified independent risk factors, which included male gender, inpatient status, smoking, dialysis dependence, transfusion within 72 hours of surgery, wound classification, ASA Class, diabetes mellitus, CHF, sepsis or septic shock, emergent case, and long initial operative time. The NRSa, NRSo, and mFI-5 were calculated for each patient and compared with area under the curve (AUC) analysis. In general, an AUC of 0.7 or greater indicates an acceptable discriminatory test.
Results: A total of 293 hand surgeries were included for study, which was determined to be sufficient on power analysis. Reoperations and readmissions occurred 2.0% and 3.4% of the time, respectively. Analysis of the cohort rendered an area under the curve of 0.928 for reoperations (NRSo), which demonstrates the high accuracy of this prediction model. Readmissions (NRSa) rendered an AUC of 0.603. In comparison, the mFI-5 rendered an AUC of 0.327 for reoperations and 0.482 for readmissions.
Conclusion: The authors present the clinical validation of a novel risk stratification score for unplanned reoperations and readmissions following hand surgery. The reoperation score provides excellent predictive ability. Both scores outperform the mFI-5 on clinical validation. Future studies may determine if prospective patients may benefit from clinical adoption.
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