Rogers et al identified risk factors associated with venous thromboembolic events (VTE) in general and vascular surgery patients. These can help identify a patient who may prevent from closer monitoring and prophylactic therapy. The authors participated in the Patient Safety in Surgery Study.
Parameter:
(1) type of surgery
(2) ASA classification
(3) gender
(4) relative value unit (RVU) for the operation
(5) disseminated cancer
(6) chemotherapy for cancer within 30 days of surgery
(7) preoperative sodium in mmol/L
(8) transfusion of blood within 72 hours before the operation
(9) ventilator status
(10) wound class
(11) preoperative hematocrit in percent
(12) dyspnea
(13) serum albumin
(14) preoperative serum total bilirubin in mg/dL
(15) timing for surgery
|
Parameter |
Finding |
Points |
|
type of surgery |
respiratory or hemic |
9 |
|
|
major vascular (embolectomy, venous reconstruction, endovascular repair, thoraco-abdominal aneurysm) |
7 |
|
|
other aneurysm |
4 |
|
|
mouth or palate (oral surgery) |
4 |
|
|
stomach or intestines (GI) |
4 |
|
|
skin |
3 |
|
|
hernia |
2 |
|
|
other |
0 |
|
ASA classification |
ASA 1 |
0 |
|
|
ASA 2 |
1 |
|
|
ASA 3 to 5 |
2 |
|
gender |
male |
0 |
|
|
female |
1 |
|
RVU for operation |
< 10 |
0 |
|
|
10 - 17 |
2 |
|
|
> 17 |
3 |
|
disseminated cancer |
absent |
0 |
|
|
present |
2 |
|
chemotherapy for cancer |
absent |
0 |
|
|
present |
2 |
|
preoperative sodium |
<= 145 mmol/L |
0 |
|
|
> 145 mmol/L |
2 |
|
transfusion before surgery |
<= 4 units |
0 |
|
|
> 4 units |
2 |
|
ventilator status |
not dependent |
0 |
|
|
dependent |
2 |
|
wound status |
clean/contaminated |
1 |
|
|
other |
0 |
|
preoperative hematocrit |
> 38 percent |
0 |
|
|
<= 38 percent |
1 |
|
dyspnea |
absent |
0 |
|
|
present |
1 |
|
serum albumin |
> 3.6 g/dL |
0 |
|
|
<= 3.5 g/dL |
1 |
|
preoperative serum total bilirubin |
<= 1.0 mg/dL |
0 |
|
|
> 1.0 mg/dL |
1 |
|
timing for surgery |
nonemergency |
0 |
|
|
emergency |
1 |
where:
• Wound classes are infected, contaminated, clean contaminated and clean.
• Table 5 has "operation type other than endocrine". Endocrine surgery was the reference group in Table 4.
• Other general and surgical procedures are not listed. These are assigned 0 points by default.
total score =
= SUM(points for all 14 parameters)
Interpretation:
• minimum score: 0
• maximum score: 31
• The higher the score the greater the risk of a venous thromboembolic event.
• The rate for a thromboembolic events increases rapidly for scores above 11. 1% of patient with a score of 11 had a VTE event, while it is 6% with a score of 19 (see Figure 1, page 1220).
|
Total Score |
Risk Group |
|
0 to 6 |
low |
|
7 to10 |
medium |
|
11 to 31 |
high |
Specialty: Hematology Oncology, Clinical Laboratory
ICD-10: ,
