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Risk Score of Marcantonio et al for Predicting Postoperative Delirium Following Elective Noncardiac Surgery

Purpose: To estimate the risk of postoperative delirium following elective noncardiac surgery using the risk score of Marcantonio et al.

Description

Marcantonio et al developed a risk score for predicting the risk of delirium following elective noncardiac surgery. This can help identify those patients who may require more aggressive management and closer monitoring in the perioperative period. The authors are from Brigham and Women's Hospital in Boston.


Patient selection: adult undergoing noncardiac surgery

 

Parameters:

(1) age of the patient

(2) alcohol abuse

(3) cognitive impairment based on the Telephone Interview for Cognitive Status (TICS, see Brandt et al)

(4) Specific Activity Scale (SAS) of Goldman et al (see 37.06.04)

(5) chemical test results (sodium, glucose, potassium)

(6) type of surgery

 

Parameter

Finding

Points

age of the patient in years

< 70 years

0

 

>= 70 years

1

alcohol abuse

absent

0

 

present

1

TICS score

>= 30 (30 to 41)

0

 

< 30 (cognitive impairment)

1

SAS class

I to III

0

 

IV (severe physical impairment)

1

chemistry test results

sodium < 130 or > 150 mmol/L

1

 

potassium < 3.0 or > 6.0 mmol/L

1

 

glucose < 3.3 or > 16.7 mmol/L (< 60 or > 300 mg/dL)

1

 

other

0

type of surgery

aortic aneurysm repair

2

 

noncardiac thoracic surgery

1

 

other

0

 

where:

• A person with SAS Class IV physical status is unable to dress or make the bed without stopping and is unable to walk 1 block at 4 km per hour)

 

total score =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 7

• The higher the score the greater the risk of postoperative delirium.

 

Total Score

Risk Group

Probability of Delirium

0

low

1 - 2%

1 or 2

medium

8 - 19%

3 to 7

high

45 - 50%

 


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Specialty

Objective

ICD-10