MDAware: Upgrading Clinical Judgment

Assessing Surgical Risk in Cirrhosis

In this episode of MD Aware: Upgrading Clinical Judgment, host Dr. Shazia Siddique sits down with Dr. Nadiem Mahmud, Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology at the University of Pennsylvania, to explore one of the most clinically impactful new tools now available on MDCalc: the VOCAL-Penn Score. Designed to predict postoperative mortality and cirrhosis decompensation in patients with liver disease, the VOCAL-Penn Score addresses a longstanding gap that has challenged hepatologists, gastroenterologists, and surgeons for decades. Dr. Mahmud walks through how the score was born out of real clinical frustration with existing tools like the MELD score, Child-Pugh score, and Mayo Risk Score, all of which frequently produced wildly discordant estimates that clashed with clinical intuition. The VOCAL-Penn Score takes a more comprehensive approach, incorporating surgery type as a key variable and delivering four distinct outputs: 30-day, 90-day, and 180-day postoperative mortality risk, as well as 90-day risk of cirrhosis decompensation. Now used by more than 50,000 clinicians annually across the globe and endorsed by both the American College of Gastroenterology and the European Association for the Study of Liver Disease, the tool is reshaping how clinicians approach surgical risk conversations with their patients. Dr. Siddique and Dr. Mahmud also dig into the common misapplications of the score, what a VOCAL-Penn 2.0 might look like, and why the move to MDCalc represents a major step forward in making this tool accessible to the four out of five US clinicians who already use the platform every day. What You'll Learn * How the VOCAL-Penn Score improves on older cirrhosis surgical risk tools by incorporating surgery type and delivering four distinct risk outputs to support shared decision-making * Why there is no single hard cutoff for proceeding with surgery, and how a 15% projected 90-day mortality threshold can serve as a trigger for preoperative liver transplant evaluation * Common pitfalls when applying the score, including using outdated lab values, applying it to unsupported surgery types, and failing to calculate risk for both laparoscopic and open surgical scenarios * What a future version of the tool may include, such as broader surgery categories, additional cardiometabolic risk factors, and more diverse patient populations Links & Resources MDCalc: https://www.mdcalc.com/mdcalc.com [https://www.mdcalc.com/] VOCAL-Penn Score on MDCalc: https://www.mdcalc.com/mdcalc.com [https://www.mdcalc.com/] VOCAL-Penn Score original site: https://www.vocalpennscore.com/vocalpennscore.com [https://www.vocalpennscore.com/] University of Pennsylvania Gastroenterology and Hepatology: https://www.pennmedicine.org/pennmedicine.org [https://www.pennmedicine.org/] American College of Gastroenterology: https://www.gi.org/gi.org [https://www.gi.org/] European Association for the Study of Liver Disease: https://www.easl.eu/easl.eu [https://www.easl.eu/] Follow MDCalc on LinkedIn: https://www.linkedin.com/company/mdcalclinkedin.com/company/mdcalc [https://www.linkedin.com/company/mdcalc] Follow MDCalc on X/Twitter: https://twitter.com/MDCalc@MDCalc [https://twitter.com/MDCalc]

Grading the Calculators: Inside MDCalc's Quality Rating System

In the inaugural episode of MD Aware: Upgrading Clinical Judgment, co-hosts Dr. Shazia Siddique and Joe Habboushe, co-founder and CEO of MDCalc, pull back the curtain on one of the most ambitious projects in MDCalc's 20-year history: the Quality Rating System (QRS). Designed to help clinicians quickly identify the most evidence-based and clinically relevant tools at the point of care, the QRS represents a major step forward in bringing transparency and rigor to the hundreds of clinical decision-making tools available today. Joining the conversation are two distinguished members of the QRS Advisory Board: Dr. Helen Burstin, CEO of the Council of Medical Specialty Societies, and Dr. Joseph Wright, Chief Health Equity Officer at the American Academy of Pediatrics. Together, they discuss how the QRS was developed using a Delphi consensus methodology, why professional society endorsement matters more than most clinicians realize, and how embedding fairness and bias detection directly into the rating criteria could reshape how clinical tools are built, validated, and used across diverse patient populations From busy emergency departments to routine office visits, the QRS promises to give every clinician the confidence to reach for the right tool at the right moment. Whether you're a frontline provider, a researcher, or a guideline developer, this episode offers a compelling look at how raising the bar for clinical tools can ultimately translate into better outcomes for every patient. What You'll Learn * The four core domains of the QRS, including importance, scientific soundness, fairness and algorithmic bias, and usability, and why each one matters at the bedside * How the Delphi consensus process brought together clinical experts to iteratively refine the rating criteria against real-world calculators * Why professional society endorsement is a key signal for clinicians, and how the QRS could push societies to keep their guidance more current * How the QRS can fuel future research by identifying gaps in evidence, surfacing potential population-level harms, and encouraging multi-institutional collaboration Links & Resources MDCalc: https://www.mdcalc.com/mdcalc.com [http://mdcalc.com] Council of Medical Specialty Societies (CMSS): https://www.cmss.org/cmss.org [http://cmss.org] American Academy of Pediatrics (AAP): https://www.aap.org/aap.org [https://www.aap.org/] Follow MDCalc on LinkedIn: https://www.linkedin.com/company/mdcalclinkedin.com/company/mdcalc [http://linkedin.com/company/mdcalc] Follow MDCalc on X/Twitter: https://twitter.com/MDCalc@MDCalc [https://twitter.com/MDCalc]