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
general surgery
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.
