Patient selection: total laryngectomy for cancer
Parameters:
(1) ASA classification (either 2 or 3)
(2) alcohol consumption
(3) chemoradiotherapy prior to surgery
(4) tracheotomy prior to surgery
(5) hemoglobin prior to surgery in 6/dL
(6) local extension
(7) N-classification (from 0 to 3)
(8) diabetes mellitus
(10) serum albumin prior to surgery in g/L
|
Parameter
|
Finding
|
Point
|
|
ASA classification
|
|
4.98 * (ASA)
|
|
alcohol consumption
|
heavy
|
1.97
|
|
|
not heavy
|
0
|
|
chemoradiotherapy
|
no
|
0
|
|
|
yes
|
5.10
|
|
tracheotomy
|
no
|
0
|
|
|
yes
|
2.40
|
|
hemoglobin
|
>= 12.4 g/dL
|
0
|
|
|
< 12.4
|
0.75
|
|
local extension
|
no
|
0
|
|
|
yes
|
0.69
|
|
N classification
|
|
1.01 * (N class)
|
|
diabetes mellitus
|
no
|
0
|
|
|
yes
|
0.75
|
|
albumin
|
>= 37 g/L
|
0
|
|
|
<= 37 g/L
|
3.03
|
where:
• The handling of hemoglobin, N classification, and albumin is ambiguous.
total score =
= SUM(points for all of the parameters)
Interpretation:
• The higher the score the greater the risk of a fistula.
|
Score
|
Risk
|
Fistula
|
|
<= 9.88 (?? 9.96)
|
low
|
11%
|
|
9.881 (??9.97) to 12.25
|
low to medium
|
20%
|
|
12.26 to 17.1
|
medium to high
|
27%
|
|
> 17.1
|
high
|
76%
|
Performance:
• The area under the ROC curve is 0.76.
