PloS one · 2026
Routinely available perioperative variables and EHR-captured postoperative adverse-event indicators after adult abdominal surgery: A retrospective cohort study using MOVER EPIC.
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Shi Anqi, Cui Xinyue, Zheng Hanling, Li Yifan
Аннотация
BACKGROUND: Perioperative electronic health record (EHR) datasets are increasingly used to study postoperative morbidity, although database-recorded adverse-event indicators may not correspond to standardized complication endpoints. We characterized these indicators after adult abdominal surgery in MOVER EPIC and examined associations with routinely available perioperative variables.
METHODS: This retrospective cohort study identified adult abdominal surgical encounters from 2017-2022 through procedure-name screening and case-level deduplication. The primary outcome was a broad composite of EHR-captured postoperative adverse-event indicators recorded within the indexed perioperative encounter. The secondary outcome was a narrower composite of severe EHR-captured adverse-event indicators. Multivariable logistic regression was performed in the primary complete-case cohort, adjusting for age, sex group, ASA physical status, procedure group, and operating-room duration. Sensitivity analyses included ASA-excluded models, alternative duration specifications, first-encounter restriction, penalized regression, patient-level cluster-robust inference, and inverse probability weighting (IPW).
RESULTS: Among 5,679 encounters, the broad composite occurred in 166 (2.92%), the narrow severe composite in 95 (1.67%), and death in 23 (0.40%). In the primary complete-case cohort (n = 5,349; 147 broad events), ASA IV + was strongly associated with the broad composite compared with ASA III (adjusted OR 4.66, 95% CI 2.92-7.45; p < 0.001). Laparotomy/adhesiolysis was also associated with higher odds (OR 1.79, 95% CI 1.02-3.13; p = 0.041), whereas spline analyses suggested modest nonlinearity in the age association; operating-room duration was not independently associated. IPW estimates were materially similar, although the estimate for ASA I-II was less precise.
CONCLUSIONS: Clinician-assigned ASA physical status was the most consistent correlate of EHR-captured postoperative adverse-event indicators. ASA may reflect comorbidity burden and perceived perioperative vulnerability rather than directly measuring physiological reserve. These findings should not be interpreted as standardized 30-day postoperative complication risks.
METHODS: This retrospective cohort study identified adult abdominal surgical encounters from 2017-2022 through procedure-name screening and case-level deduplication. The primary outcome was a broad composite of EHR-captured postoperative adverse-event indicators recorded within the indexed perioperative encounter. The secondary outcome was a narrower composite of severe EHR-captured adverse-event indicators. Multivariable logistic regression was performed in the primary complete-case cohort, adjusting for age, sex group, ASA physical status, procedure group, and operating-room duration. Sensitivity analyses included ASA-excluded models, alternative duration specifications, first-encounter restriction, penalized regression, patient-level cluster-robust inference, and inverse probability weighting (IPW).
RESULTS: Among 5,679 encounters, the broad composite occurred in 166 (2.92%), the narrow severe composite in 95 (1.67%), and death in 23 (0.40%). In the primary complete-case cohort (n = 5,349; 147 broad events), ASA IV + was strongly associated with the broad composite compared with ASA III (adjusted OR 4.66, 95% CI 2.92-7.45; p < 0.001). Laparotomy/adhesiolysis was also associated with higher odds (OR 1.79, 95% CI 1.02-3.13; p = 0.041), whereas spline analyses suggested modest nonlinearity in the age association; operating-room duration was not independently associated. IPW estimates were materially similar, although the estimate for ASA I-II was less precise.
CONCLUSIONS: Clinician-assigned ASA physical status was the most consistent correlate of EHR-captured postoperative adverse-event indicators. ASA may reflect comorbidity burden and perceived perioperative vulnerability rather than directly measuring physiological reserve. These findings should not be interpreted as standardized 30-day postoperative complication risks.