Le Manach et al reported the Preoperative Score to Predict Postoperative Mortality (POSPOM). This can help to identify a patient who may require more aggressive management. The authors are from multiple institutions in Canada, South Africa and France.
Patient selection: preoperative assessment of patient
Outcome: in-hospital mortality
Parameters:
(1) age of the patient in years
(2) ischemic heart disease
(3) cardiac arrhythmia or heart block
(4) chronic heart failure or cardiomyopathy
(5) peripheral vascular disease
(6) dementia
(7) cerebrovascular disease
(8) hemiplegia
(9) COPD
(10) chronic respiratory failure
(11) chronic alcohol abuse
(12) cancer
(13) diabetes mellitus
(14) transplanted organs
(15) preoperative chronic hemodialysis
(16) chronic renal failure
(17) type of surgery
|
Age |
Points |
|
18-20 |
0 |
|
21-25 |
1 |
|
26-30 |
2 |
|
31-35 |
3 |
|
36-40 |
4 |
|
41-45 |
5 |
|
46-50 |
6 |
|
51-55 |
7 |
|
56-60 |
8 |
|
61-65 |
9 |
|
66-70 |
10 |
|
71-75 |
11 |
|
76-80 |
12 |
|
81-85 |
13 |
|
86-90 |
14 |
|
91-95 |
15 |
|
>= 96 |
16 |
|
Parameter |
Finding |
Points |
|
ischemic heart disease |
no |
0 |
|
|
yes |
1 |
|
cardiac arrhythmia or heart block |
no |
0 |
|
|
yes |
1 |
|
chronic heart failure or cardiomyopathy |
no |
0 |
|
|
yes |
4 |
|
peripheral vascular disease |
no |
0 |
|
|
yes |
1 |
|
dementia |
no |
0 |
|
|
yes |
2 |
|
cerebrovascular disease |
no |
0 |
|
|
yes |
1 |
|
hemiplegia |
no |
0 |
|
|
yes |
4 |
|
COPD |
no |
0 |
|
|
yes |
1 |
|
chronic respiratory failure |
no |
0 |
|
|
yes |
3 |
|
chronic alcohol abuse |
no |
0 |
|
|
yes |
4 |
|
cancer |
no |
0 |
|
|
yes |
4 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
1 |
|
transplanted organs |
no |
0 |
|
|
yes |
2 |
|
preoperative chronic hemodialysis |
no |
0 |
|
|
yes |
1 |
|
chronic renal failure |
no |
0 |
|
|
yes |
2 |
|
Planned Surgery |
Points |
|
cardiac |
17 |
|
ENT |
9 |
|
GI, endoscopic |
0 |
|
GI, major |
16 |
|
GI, minor |
13 |
|
gynecologic |
6 |
|
hepatic, major |
15 |
|
hepatic, minor |
12 |
|
interventional cardiorhythmology |
8 |
|
interventional neuroradiology |
17 |
|
multiple trauma |
22 |
|
neurosurgery |
15 |
|
ophthalmologic |
0 |
|
orthopedic, arthroplasty or spine |
9 |
|
orthopedic, other |
6 |
|
orthopedic, trauma |
14 |
|
plastic |
9 |
|
thoracic |
15 |
|
transplant, other |
22 |
|
transplant, renal |
13 |
|
urologic, major |
12 |
|
urologic, minor |
9 |
|
vascular, major |
16 |
|
vascular, minor |
13 |
|
other surgery |
12 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score for age: 16
• maximum score for patient related factors: 32
• maximum score for surgical type: 22
• maximum total score: 70
• The higher the score the greater the risk of postoperative mortality.
|
Score |
In-Hospital Mortality in Percent |
|
0 |
< 0.001 |
|
1 |
0.001 |
|
2 |
0.002 |
|
3 |
0.002 |
|
4 |
0.003 |
|
5 |
0.004 |
|
6 |
0.006 |
|
7 |
0.008 |
|
8 |
0.010 |
|
9 |
0.014 |
|
0.019 |
|
|
11 |
0.026 |
|
12 |
0.035 |
|
13 |
0.05 |
|
14 |
0.06 |
|
15 |
0.09 |
|
16 |
0.12 |
|
17 |
0.16 |
|
18 |
0.21 |
|
19 |
0.29 |
|
20 |
0.39 |
|
21 |
0.52 |
|
22 |
0.71 |
|
23 |
0.95 |
|
24 |
1.3 |
|
25 |
1.7 |
|
26 |
2.3 |
|
27 |
3.1 |
|
28 |
4.2 |
|
29 |
5.6 |
|
30 |
7.4 |
|
31 |
9.8 |
|
32 |
13 |
|
33 |
17 |
|
34 |
21 |
|
35 |
27 |
|
36 |
33 |
|
37 |
40 |
|
38 |
47 |
|
39 |
55 |
|
40 |
62 |
|
41 |
69 |
|
42 |
75 |
|
43 |
80 |
|
44 |
85 |
|
45 |
88 |
|
46 |
91 |
|
47 |
93 |
|
48 |
95 |
|
49 |
96 |
|
50 |
97 |
|
>= 51 |
>=98% |
Performance:
• The area under the ROC curve is 0.93-0.94.
Specialty: Anesthesiology, Surgery, general
