Sobotka et al developed a model for predicting 30-day hospital readmission for a patient with ulcerative colitis (UC) following surgery for colectomy or proctectomy. This can help to identify a patient who may benefit from more aggressive management. The authors are from the Ohio State University in Columbus.
Patient selection: status post colectomy or proctectomy
Parameters:
(1) deep vein thrombosis or thrombophlebitis
(2) pulmonary embolism
(3) renal insufficiency
(4) surgical site infection (SSI)
(5) return to the operating room
(6) congestive heart failure in the 30 days prior to surgery
(7) urinary tract infection
(8) sepsis or septic shock
(9) proctocolectomy with IPAA (ileal pouch-anal anastomosis) creation and diverting ileostomy
(10) other surgeries (proctectomy, combined abdominoperineal pull-through, etc)
(11) length of stay
(12) hypertension requiring medication
(13) steroid use for a chronic condition
(14) pre-operative serum albumin
(15) operative time
(16) ethnic group
|
Parameter |
Finding |
Points |
|
deep vein thrombosis |
absent |
0 |
|
|
present |
15 |
|
pulmonary embolism |
absent |
0 |
|
|
present |
13 |
|
renal insufficiency |
absent |
0 |
|
|
present |
12 |
|
surgical site infection |
absent |
0 |
|
|
present |
11 |
|
return to OR |
no |
0 |
|
|
yes |
12 |
|
CHF |
absent |
0 |
|
|
present |
10 |
|
urinary tract infection |
absent |
0 |
|
|
present |
9 |
|
sepsis or septic shock |
absent |
0 |
|
|
present |
7 |
|
proctocolectomy with IPAA and diverting ileostomy |
no |
0 |
|
|
yes |
5 |
|
other surgeries |
no |
0 |
|
|
yes |
5 |
|
length of stay |
< 7 days |
4 |
|
|
>= 7 days |
0 |
|
hypertension |
no |
0 |
|
|
yes |
3 |
|
steroid use |
no |
0 |
|
|
yes |
2 |
|
serum albumin |
< 3.5 g/dL |
2 |
|
|
>= 3.5 g/dL |
0 |
|
operative time |
<= 240 minutes |
0 |
|
|
> 240 minutes |
no value |
|
ethnic group |
Hispanic |
5 |
|
|
other |
0 |
score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 115
• The higher the score the greater the risk of readmission.
|
Score |
Readmission |
|
< 10 |
10% |
|
10 to 19 |
18.5% |
|
20 to 29 |
52% |
|
>= 30 |
60% |
