The goal of the MBSAQIP risk/benefit calculator is to provide accurate, patient-specific risk/benefit information to guide both surgical decision-making and informed consent. The risk/benefit calculator uses 20 patient predictors (e.g., age, ASA class, preoperative BMI, etc.) to predict the chance that patients will have any of 9 different outcomes within 30-days following surgery. These outcomes include:
- Serious Complication (Death; Related, Unplanned Reoperation; Unplanned Admission to the ICU; Organ/Space SSI; Pneumonia; Unplanned Intubation; Pulmonary Embolism; On Ventilator > 48 hours; Progressive Renal Insufficiency; Acute Renal Failure; Stroke/Cerebral Vascular Accident; Coma > 24 hours; Cardiac Arrest Requiring CPR; Myocardial Infarction; Transfusion; Vein Thrombosis Requiring Therapy; Sepsis; Septic Shock)
- Any Complication (Superficial Incisional SSI; Deep Incisional SSI; Organ/Space SSI; Wound Disruption; Pneumonia; Unplanned Intubation; Pulmonary Embolism; On Ventilator > 48 hours; Progressive Renal Insufficiency; Acute Renal Failure; Urinary Tract Infection; Stroke/Cerebral Vascular Accident; Coma > 24 hours; Peripheral Nerve Injury; Cardiac Arrest Requiring CPR; Myocardial Infarction; Transfusion; Vein Thrombosis Requiring Therapy; Sepsis; Septic Shock; Unplanned Admission to the ICU; Reoperation/Intervention/Readmission for one of the following: Abdominal Pain, Not Otherwise Specified; Anastomotic Ulcer; Anastomotic/Staple Line Leak; Band Erosion; Band Slippage/Prolapse; Bile Reflux Gastritis; Bleeding; Cardiac, Not Otherwise Specified (arrhythmias, congestive heart failure); Cerebral Vascular Accident; GI Perforation; Gallstone Disease; Gastric Distention; Gastro-Gastric Fistula; Incisional Hernia; Infection/Fever; Internal Hernia; Intestinal Obstruction; LAGB - Port, Tubing or Band Problem; Myocardial Infarction; Nausea and Vomiting, Fluid, Electrolyte, or Nutritional Depletion; Other Abdominal Sepsis; Other Respiratory Failure; Pneumonia; Pulmonary Embolism; Renal Insufficiency; Strictures/Stomal Obstruction; Vein Thrombosis Requiring Therapy; Wound Infection/Evisceration)
- Leak (Reoperation/Intervention/Readmission for Anastomotic/Staple Line Leak) – please note the outcome ‘Leak’ is clinically N/A for Band procedures. As such, on the 30-day Risk bar plots you will not see a ‘Band’ bar for the outcome 'Leak'.
- Bleed (Transfusion of RBCs or Reoperation/Intervention/Readmission for Bleeding)
- Surgical Site Infection (Superficial Incisional SSI, Deep Incisional SSI, Organ/Space SSI)
In addition, the risk/benefit calculator uses the same 20 patient predictors to predict the chance that patients will be in remission at 1 year after surgery for up to 5 different weight-related comorbidities. Note that remission predictions for a particular weight-related comorbidity are only provided if the preoperative weight-related comorbidity is entered as a patient predictor. The 5 weight-related comorbidities include:
- Sleep Apnea
Lastly, the risk/benefit calculator uses the same 20 patient predictors to predict the BMI, weight change, and percent total weight change trajectories for patients up to 1 year after surgery. The current version of the risk/benefit calculator was built using data collected from over 775,000 operations across 955 participating MBSAQIP centers from January 1, 2015 to December 31, 2019. Entering the most complete and accurate patient information will provide the most precise risk/benefit information. However, the estimates can still be calculated if some of the patient information is unknown.
The original bariatric surgical risk/benefit calculator was built using data collected from over 775,000 operations at 925 centers participating in MBSAQIP from January 1, 2013 - June 30, 2018. Detailed information regarding the methodology and process behind generating the models for the 30-Day risk prediction tool can be found here:
Grieco, A., Huffman, K.M., Cohen, M.E., Hall, B.L., Morton, J.M., Ko, C.Y. (2021). The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program bariatric surgical risk/benefit calculator: 30-day risk. Surgery for Obesity and Related Diseases. doi: 10.1016/j.soard.2021.02.005.
Manuscripts detailing the construction and performance of the 1-Year BMI and 1-Year Comorbidity Remission tools are forthcoming.
Please note the MBSAQIP data registry underwent extensive restructuring in January 2020. As such, the next iteration of the Bariatric Risk/Benefit Calculator will be remodeled, as well, to reflect this new data.