Lipton et al developed a Preoperative Risk Score (ORS) for predicting postoperative complications in children with cerebral palsy undergoing spinal fusion to manage scoliosis. This can help with informing parents of the competing risks involved. The authors are from Temple University and the Alfred duPont Institute.
Parameters:
(1) ambulatory status
(2) mental retardation
(3) speech
(4) feeding abilities
(5) medical and surgical problems in the past year
(6) care delivery site
(7) weight for age as Z score
(8) degree of scoliosis deformity
|
Parameter |
Finding |
Points |
|
ambulatory status |
community |
0 |
|
|
community with assistance |
1 |
|
|
household (? housebound) |
2 |
|
|
exercise in transfer (?assistance in transfer) |
3 |
|
|
nonambulatory |
4 |
|
mental retardation |
none |
0 |
|
|
slight |
0 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
speech |
full |
0 |
|
|
limited |
0 |
|
|
none |
5 |
|
feeding abilities |
self feeding |
0 |
|
|
oral feeding |
2 |
|
|
oral and gastrostomy-tube feeding |
2 |
|
|
gastrostomy-tube only |
4 |
|
medical and surgical history |
none |
0 |
|
|
pneumonia |
3 |
|
|
reflux |
2.5 |
|
|
esophagitis |
2.4 |
|
|
gastrostomy tube placement |
1 |
|
|
constipation |
0.5 |
|
|
seizures |
2 |
|
|
shunt |
0.9 |
|
|
vomiting |
1.5 |
|
|
bronchitis or asthma |
1.8 |
|
|
gastritis |
2.1 |
|
|
urinary tract infection |
0.75 |
|
care |
home |
0 |
|
|
institution |
1 |
|
degree of deformity |
0 to 50° |
0 |
|
|
51 to 100° |
1 |
|
|
> 100° |
2 |
from Table 1, page 199
points for weight for age =
= ((Z score for weight for age) – (1 standard deviation)) * 1.7
where:
• Z-score = ((patient value) - (mean for reference population)) / (standard deviation for reference population)
preoperative risk score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: negative score determined by weight for age (perhaps –5)
• maximum score: probably greater than 45
• Most patients are in the range 5 to 40 points.
• The higher the ORS the greater the risk for postoperative complications.
• The authors developed a postoperative complication scale (POCS). The OPS correlated with this score by the relationship:
POCS =
= (0.65 * (OPS)) – 4.65
Specialty: Surgery, orthopedic
