Tevis et al developed a nomogram for identifying a patient who may be readmitted within 30 days of general surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Wisconsin.
Patient selection: general surgery, ASA from 1 to 4
Outcome: 30-day readmission
Parameters:
(1) corticosteroid use
(2) weight loss > 10% in 6 months
(3) bleeding disorder
(4) prolonged operative time
(5) surgical specialty
(6) ASA classification
(7) wound classification
(8) in-hospital complication
(9) dependent or higher level of care
Operation |
Prolonged |
minimally invasive |
> 133 minutes |
colorectal |
> 259 minutes |
general surgery |
> 155 minutes |
hepatobiliary |
> 356 minutes |
Parameter |
Finding |
Points |
corticosteroid use |
no |
0 |
|
yes |
60 |
weight loss |
no |
0 |
|
yes |
40 |
bleeding disorder |
no |
0 |
|
yes |
99 |
prolonged operative time |
no |
0 |
|
yes |
8.4 |
surgical specialty |
minimally invasive |
0 |
|
36.6 |
|
|
hepatobiliary |
50 |
|
colorectal |
53 |
ASA classification |
1 or 2 |
0 |
|
3 or 4 |
16 |
wound classification |
clean |
0 |
|
contaminated |
33 |
|
clean-contaminated |
57 |
|
dirty |
100 |
in-hospital complication |
no |
0 |
|
yes |
60 |
dependent or high-level care |
no |
0 |
|
yes |
25 |
where:
• Soft tissue oncology surgery was discussed in the text but not in the nomogram. It was paired with hepatobiliary surgery.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 461.4
• The higher the score the greater the 30-day readmission rate.
Total Score |
Percent Readmission |
0 to 400 |
(0.000313 * ((score)^2)) + (0.01551*(score)) + 3.89) |
> 400 |
> 60% |