Wang et al reported a nomogram for predicting severe morbidity following pheochromocytoma surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from Shengjing Hospital of China Medical University in Shenyang, China.
Patient selection: status post pheochromocytoma surgery
Outcome: Clavien-Dindo grade II or above
Parameters:
(1) body mass index (BMI) in kilograms per square meter
(2) intraoperative hemodynamic instability (IHD, at least one systolic blood pressure reading > 200 mm Hg OR mean arterial pressure < 60 OR need for pressors OR blood transfusion to maintain a normal blood pressure)
(3) sex
(4) coronary heart disease
(5) duration of the operation in minutes, from 0 to 500
(6) tumor size in cm, from 0 to 18 cm
(7) cardiac arrhythmia
points for BMI =
= 142.857 - (3.571 * (BMI))
points for operative duration =
= (0.0718 * (duration))
points for tumor diameter =
= (1.7777 * (diameter))
|
Parameter
|
Finding
|
Points
|
|
hemodynamic instability
|
no
|
0
|
|
|
yes
|
15.2
|
|
sex
|
male
|
0
|
|
|
female
|
13.4
|
|
coronary heart disease
|
no
|
0
|
|
|
yes
|
11.7
|
|
cardiac arrhythmia
|
no
|
0
|
|
|
yes
|
18.8
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 227
• The higher the score the greater the risk of a severe morbidity after surgery.
value of X =
= (0.06876 * (score)) - 8.158
probability of severe morbidity =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.82.
