Tseng et al reported models for predicting 30-day outcomes following surgery for a patient with disseminated cancer. One model predicts morbidity and the second mortality. The authors are from the University of California at Davis.
Patient selection: surgical intervention on a patient with disseminated cancer
Parameters:
(1) DNR status
(2) weight loss over 6 months
(3) dyspnea
(4) functional dependence
(5) ascites
(6) chronic steroid use
(7) active sepsis
(8) serum creatinine in mg/dL
(9) serum albumin in g/dL
(10) blood WBC count in 10^9/L
(11) hematocrit in percent
(12) surgical acuity
(13) procedure type
points for serum creatinine =
= 6.95 * (creatinine)
points for serum albumin =
= 84.82 - (15.42 * (albumin))
points for WBC count =
= (0.834 * (WBCC))
points for hematocrit =
|
Parameter
|
Finding
|
Points
|
|
DNR status
|
no
|
0
|
|
|
yes
|
30.9
|
|
weight loss
|
<= 10%
|
0
|
|
|
> 10%
|
13.7
|
|
dyspnea
|
no
|
0
|
|
|
moderate
|
15.3
|
|
|
at rest
|
28.9
|
|
functional dependence
|
none
|
0
|
|
|
partial
|
41
|
|
|
total
|
74.6
|
|
ascites
|
no
|
0
|
|
|
yes
|
13
|
|
chronic steroid use
|
no
|
0
|
|
|
yes
|
14.6
|
|
active sepsis
|
no
|
0
|
|
|
yes
|
29.4
|
|
surgical acuity
|
elective
|
0
|
|
|
urgent
|
9.6
|
|
|
emergency
|
21.5
|
|
procedure type
|
skin or soft tissue
|
0
|
|
|
vascular
|
16.1
|
|
|
biopsy
|
25.8
|
|
|
gallbladder, appendix, lysis of adhesions
|
36.5
|
|
|
gastrointestinal resection
|
52.9
|
|
|
multivisceral resection
|
100
|
|
|
other
|
22.6
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum sore: 530.4
value of X =
= (0.01626 * (score)) - 3.365
probability of 30-day morbidity =
= 1 / (1 + EXP((-1) * X))
Performance:
• The concordance index is 0.70.
