Surgical risk calculators in veterans following lower extremity amputation

• Published in: The American journal of surgery 2022-06, Vol.223 (6), p.1212-1216
• Main Authors: Buckner, Jacob, Cabot, John, Fields, Alyssa, Pounds, Lori, Quint, Clay
• Format: Article
• Language: English
• Subjects: ACS-NSQIP; Amputation; Calculators; Decision making; Major lower extremity amputation; Mathematical analysis; Mortality; Risk assessment; Risk calculators; Veterans
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2021.12.008

To evaluate the accuracy of multiple risk calculators for 30-day mortality on patients undergoing major lower extremity amputation. The actual 30-day mortality at a single Veterans Affairs institution was compared to the predicted outcome from the following risk calculators: ACS-NSQIP, VASQIP, amputation scoring tool (AST), and POTTER elective. The overall calculated 30-day mortality was similar to the actual mortality with the VASQIP and POTTER elective risk calculators, while the NSQIP and AST over-estimated the 30-day mortality. The predictive accuracy of the POTTER and NSQIP risk calculators were moderate (AUC >0.7), and fair for the VASQIP and AST. Risk assessment tools can provide adjunctive data on predicted 30-day mortality in patients undergoing major lower extremity amputation. In our study, there were differences in predictability of the risk calculators for lower extremity amputation that should be considered when utilizing a risk assessment tool to improve physician-patient shared decision-making. •Risk calculators provide adjunctive data on 30-day mortality for veterans undergoing major lower extremity amputation.•Optimal Classification Tree risk calculator was more accurate compared to NSQIP or VASQIP in our amputation population.•Risk assessment tools should be considered to improve physician-patient shared decision-making.