Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery

Edward N Yap; Jie Huang; Joshua Chiu; Robert W Chang; Bradley Cohn; Judith C F Hwang; Mary Reed

doi:10.1186/s12871-024-02880-4

Development and validation of an EHR-based risk prediction model for geriatric patients undergoing urgent and emergency surgery

BMC Anesthesiol. 2025 Jan 27;25(1):33. doi: 10.1186/s12871-024-02880-4.

Authors

Edward N Yap^{1

2}, Jie Huang³, Joshua Chiu⁴, Robert W Chang^{3

5}, Bradley Cohn⁶, Judith C F Hwang⁷, Mary Reed³

Affiliations

¹ Department of Anesthesia, The Permanente Medical Group, Kaiser Permanente South San Francisco, 1200 El Camino Real, South San Francisco, CA, 94080, USA. Edward.N.Yap@kp.org.
² Department of Anesthesia and Perioperative Care, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA. Edward.N.Yap@kp.org.
³ Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
⁴ Department of Anesthesia and Perioperative Care, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA.
⁵ Department of Vascular Surgery, The Permanente Medical Group, 1200 El Camino Real, South San Francisco, CA, 94080, USA.
⁶ Department of Anesthesia, The Permanente Medical Group, 3600 Broadway, Oakland, CA, 94611, USA.
⁷ Department of Anesthesia, The Permanente Medical Group, 975 Sereno Dr, Vallejo, CA, 94589, USA.

Abstract

Background: Clinical determination of patients at high risk of poor surgical outcomes is complex and may be supported by clinical tools to summarize the patient's own personalized electronic health record (EHR) history and vitals data through predictive risk models. Since prior models were not readily available for EHR-integration, our objective was to develop and validate a risk stratification tool, named the Assessment of Geriatric Emergency Surgery (AGES) score, predicting risk of 30-day major postoperative complications in geriatric patients under consideration for urgent and emergency surgery using pre-surgical existing electronic health record (EHR) data.

Methods: Patients 65-years and older undergoing urgent or emergency non-cardiac surgery within 21 hospitals 2017-2021 were used to develop the model (randomly split: 80% training, 20% test). The primary outcome was a 30-day composite outcome including several postoperative major complications and mortality; secondary outcomes included common individual complications included in the primary composite outcome (sepsis, progressive renal insufficiency or renal failure, and mortality). Patients' EHR-based clinical history, vital signs, labs, and demographics were included in logistic regression, LASSO, decision tree, Random Forest, and XGBoost models. Area under the receiver operating characteristics curve (AUCROC) was used to compare model performance.

Results: Overall, 66,262 patients (median [IQR] age 78 [(70.9-84.0], female 53.9%, White race 68.5%) received urgent or emergency non-cardiac surgery (25.7% orthopedic cases, 21.9% general surgery cases). AUCROC ranged from 0.655 (Decision Tree) - 0.804 (XGBoost) for the primary composite outcome. XGBoost AUCROC was 0.823, 0.781, and 0.839 in predicting outcomes of sepsis, progressive renal insufficiency or renal failure, and mortality, respectively.

Conclusions: We developed a model to accurately predict major postoperative complications in geriatric patients undergoing urgent or emergency surgery using the patient's own existing EHR data. EHR implementation of this model could efficiently support clinicians' surgical risk assessment and perioperative decision-making discussions in this vulnerable patient population.

Keywords: Emergency surgery; Geriatric surgery; Risk prediction model.

Publication types

Validation Study
Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Electronic Health Records*
Emergencies
Female
Geriatric Assessment / methods
Humans
Male
Postoperative Complications* / epidemiology
Risk Assessment / methods
Surgical Procedures, Operative