Margenthaler et al evaluated adults after appendectomy for risk factors associated with 30-day mortality. This can help identify patients who may benefit from more aggressive monitoring and management. The authors are from St Louis University, Harvard Medical School, and the Veterans Administration.
Parameters:
(1) ASA class
(2) functional health status
(3) surgical wound status
(4) history of COPD
(5) chronic steroid use
(6) bleeding disorder
(7) current pneumonia
(8) diabetes mellitus requiring insulin
(9) blood transfusion
(10) preoperative alkaline phosphatase
(11) age in years
(12) preoperative BUN
(13) preoperative albumin
|
Parameter |
Finding |
Points |
|
ASA class |
I or II |
|
|
|
III |
|
|
|
IV or V |
0.8519 |
|
health status |
independent |
0 |
|
|
partially dependent |
0 |
|
|
totally dependent |
1.3868 |
|
surgical wound status |
clean |
0 |
|
|
clean-contaminated |
(-1.2227) |
|
|
contaminated or infected |
0 |
|
history of COPD |
none |
0 |
|
|
present |
1.0820 |
|
chronic steroid use |
absent |
0 |
|
|
present |
1.6697 |
|
bleeding disorder |
absent |
0 |
|
|
present |
1.2622 |
|
pneumonia |
absent |
0 |
|
|
present |
1.1682 |
|
diabetes requiring insulin |
absent |
0 |
|
|
present |
0.7953 |
|
blood transfusion |
<= 4 units packed RBCs |
0 |
|
|
> 4 units packed RBCs |
0.4441 |
|
Parameter |
Points |
|
preoperative alkaline phosphatase in µg/L |
(alkaline phosphatase) * 0.0087 |
|
age in years |
(age) / 10 * 0.6318 |
|
preoperative BUN in mg/dL |
(BUN) * 0.0275 |
|
preoperative albumin in g/dL |
(albumin) * (-0.5170) |
where:
• Age decade could either be (age)/10, INT((age/10)) or ROUND((age)/10,0). I will use the INT version in the spreadsheet.
• The age of patients ranged from 17 to 104 years.
• I am unfamiliar with the alkaline phosphatase units used (µg/L).
X =
= SUM(points for all of the parameters) - 5.9119
probability of 30-day mortality =
= 1 / (1 + EXP((-1) * X)
Specialty: Gastroenterology, Pedatrics, General Surgery
ICD-10: ,
