MacLean et al reported a nomogram for predicting inpatient admission for an older adult undergoing a primary total shoulder arthroplasty. The authors are from Rush University Medical Center, Westchester Medical Center and Rothman Orthopaedic Institute.
Patient selection: age >= 65 years, primary total joint arthroplasty
Outcome: hospital stay > 2 days
Parameers:
(1) age
(2) gender
(3) race
(4) BMI in kg per square meter
(5) current smoker
(6) chronic steroid user
(7) ASA classification
(8) functional status
(9) diabetes
(10) hypertension
(11) COPD
(12) CHF
(13) bleeding disorder
(14) dyspnea
(15) dialysis
(16) chronic renal failure
(17) surgical diagnosis
(18) admission from facility
|
Parameter |
Finding |
Points |
|
age in years |
65 to 69 years |
0 |
|
|
70 to 74 years |
7 |
|
|
75 to 79 years |
26 |
|
|
80 to 85 years |
43.4 |
|
gender |
male |
0 |
|
|
female |
33.3 |
|
race |
Asian |
0 |
|
|
White |
52 |
|
|
Black |
64 |
|
|
other |
68.6 |
|
BMI class |
< 18.5 |
14.2 |
|
|
18.5 to 25 |
2.7 |
|
|
25 to 29 |
0 |
|
|
30 to 39 |
5.8 |
|
|
>= 40 |
15.7 |
|
current smoker |
no |
0 |
|
|
yes |
9.7 |
|
chronic steroid use |
no |
0 |
|
|
yes |
6.2 |
|
ASA classification |
1 or 2 |
0 |
|
|
3 to 5 (ASA unlikely) |
19.5 |
|
functional status |
independent |
0 |
|
|
dependent |
19.5 |
|
diabetes |
no |
0 |
|
|
yes |
9.3 |
|
hypertension |
no |
0 |
|
|
yes |
7.8 |
|
COPD |
no |
0 |
|
|
yes |
13.2 |
|
CHF |
no |
0 |
|
|
yes |
22.5 |
|
bleeding disorder |
no |
0 |
|
|
yes |
32 |
|
dyspnea |
none |
0 |
|
|
with moderate exertion |
10.3 |
|
|
at rest |
41.7 |
|
dialysis |
no |
0 |
|
|
yes |
38.9 |
|
chronic renal failure |
no |
0 |
|
|
yes |
100 |
|
surgical diagnosis |
post-traumatic |
0 |
|
|
osteoarthritis |
31 |
|
|
osteonecrosis |
55.8 |
|
|
inflammatory arthritis |
91.8 |
|
admitted from facility |
no |
0 |
|
|
yes |
46.5 |
total score =
= SUM(points for all of the parameters)
Intepretation:
• minimum score: 0
• maximum score: 619.5
• The higher the score the greater the likelihood of hospital admission.
value of X =
= ( 0.02307* (score)) - 4.977
probability of inpatient stay greater than 2 days =
= 1 / (1 + EXP((-1) * X))
