{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:19:23Z","timestamp":1792790363529,"version":"4.5.0"},"posted":{"date-parts":[[2026,9,16]]},"group-title":"Anesthesia","reference-count":21,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Institute of General Medical Sciences (NIGMS), National Institutes of Health","award":["T32GM007592"],"award-info":[{"award-number":["T32GM007592"]}],"id":[{"id":"https:\/\/ror.org\/04q48ey07","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,16]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Perioperative cardiac arrest is associated with high mortality, but population-level estimates of outcomes after perioperative cardiopulmonary resuscitation (CPR) do not account for differences in risk among individual patients. We previously developed the CPR OutcoMes Prediction for Arrest in Surgical Settings (COMPASS) model to estimate 30-day mortality after cardiac arrest requiring CPR on the day of surgery. The model incorporates 33 preoperative predictors and has not been evaluated in a temporally distinct cohort. We therefore sought to temporally validate COMPASS and to develop and temporally validate a simplified point-based mortality score.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a retrospective prognostic study of adults undergoing noncardiac surgery who experienced cardiac arrest requiring CPR on postoperative day 0 in the American College of Surgeons National Surgical Quality Improvement Program. The primary outcome was 30-day mortality. The published COMPASS model, developed using 2012\u20132023 data, was applied without refitting to the 2024 cohort. A simplified point-based score was developed in the 2012\u20132023 cohort and temporally validated in 2024. Performance was assessed using discrimination, calibration, and Brier score.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The 2024 temporal validation cohort included 429 patients, of whom 274 (63.9%) died within 30 days. The COMPASS model had an area under the receiver operating characteristic curve (AUROC) of 0.82 (95% CI, 0.78\u20130.86), calibration intercept of 0.24, calibration slope of 1.10, and Brier score of 0.17. The simplified 3-variable score incorporating age, American Society of Anesthesiologists physical status, and case urgency had an AUROC of 0.81 (95% CI, 0.77\u20130.86), calibration intercept of 0.19, calibration slope of 1.25, and Brier score of 0.17.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In a temporally distinct cohort, the published COMPASS model retained predictive performance for 30-day mortality after perioperative CPR. The simplified score showed similar performance. These findings support further evaluation of both approaches as tools for individualized estimation of perioperative CPR mortality.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.15.26363126","type":"posted-content","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:15:23Z","timestamp":1789607723000},"source":"Crossref","is-referenced-by-count":0,"title":["Temporal Validation and Simplification of Mortality Prediction for Perioperative Cardiopulmonary Resuscitation"],"prefix":"10.64898","author":[{"given":"Lucy","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Mass General Brigham, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Justice","sequence":"additional","affiliation":[{"name":"Mass General Brigham AI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siva","family":"Muthupalaniappan","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8400-6888","authenticated-orcid":false,"given":"Sachin J.","family":"Shah","sequence":"additional","affiliation":[{"name":"Center for Optimal Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital"},{"name":"Department of Medicine, Mass General Brigham, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9782-5567","authenticated-orcid":false,"given":"Matthew B.","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Mass General Brigham, Boston, MA"},{"name":"Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026092102050603000_2026.09.15.26363126v1.1","doi-asserted-by":"publisher","DOI":"10.1097\/aln.0000000000000873"},{"key":"2026092102050603000_2026.09.15.26363126v1.2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16157"},{"key":"2026092102050603000_2026.09.15.26363126v1.3","unstructured":"American Society of Anesthesiologists: Statement on Ethical Guidelines for the Anesthesia Care of Patients with Do-Not-Resuscitate Orders. Reaffirmed October 18, 2023. Available at: https:\/\/www.asahq.org\/standards-and-practice-parameters\/statement-on-ethical-guidelines-for-the-anesthesia-care-of-patients-with-do-not-resuscitate-orders. Accessed August 9, 2026."},{"key":"2026092102050603000_2026.09.15.26363126v1.4","unstructured":"American College of Surgeons: Statement on Advance Directives by Patients: \u201cDo Not Resuscitate\u201d in the Operating Room. January 3, 2014. Available at: https:\/\/www.facs.org\/about-acs\/statements\/advance-directives-by-patients-do-not-resuscitate-in-the-operating-room\/. Accessed August 9, 2026."},{"key":"2026092102050603000_2026.09.15.26363126v1.5","unstructured":"American College of Surgeons: Optimal Resources for Geriatric Surgery: 2019 Standards. 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