Iannuzzi et al developed a score for predicting unplanned readmission following vascular surgery. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Rochester.
Patient selection: vascular surgery
Outcome: unplanned readmission within 30 days
Parameters:
(1) race
(2) pulmonary comorbidity
(3) cardiac comorbidity
(4) renal comorbidity
(5) serum albumin
(6) hematocrit
(7) steroid therapy
(8) bleeding disorder
(9) diabetes mellitus
(10) timing of case
(11) operative time in minutes
(12) procedure
(13) disposition following discharge
(14) venous thromboembolism before discharge
(15) graft failure before discharge
|
Parameter |
Finding |
Points |
|
race |
black (Afican American) |
1 |
|
|
other |
0 |
|
pulmonary comorbidity |
no |
0 |
|
|
yes |
2 |
|
cardiac comorbidity |
no |
0 |
|
|
yes |
2 |
|
renal comorbidity |
no |
0 |
|
|
yes |
1 |
|
serum albumin |
>= 3.5 g/dL |
0 |
|
|
< 3.5 g/dL (hypoalbuminemia) |
2 |
|
hematocrit |
>= 36 percent |
0 |
|
|
< 36 percent |
2 |
|
steroid therapy |
no |
0 |
|
|
yes |
2 |
|
bleeding disorder |
no |
0 |
|
|
yes |
1 |
|
diabetes |
no |
0 |
|
|
yes |
1 |
|
timing of case |
elective |
0 |
|
|
nonelective (emergency, urgent) |
1 |
|
operative time |
<= 150 minutes |
0 |
|
|
> 150 minutes |
1 |
|
procedure |
carotid endarterectomy |
0 |
|
|
endovascular abdominal aortic repair (EVAR) |
0 |
|
|
open AAA |
3 |
|
|
peripheral vascular |
5 |
|
|
amputation |
1 |
|
|
other |
3 |
|
disposition |
home |
0 |
|
|
nursing home |
3 |
|
|
rehabilitation facility |
2 |
|
venous thromboembolism |
no |
0 |
|
|
yes |
4 |
|
graft failure |
no |
0 |
|
|
yes |
5 |
where:
• In Table II hematocrit is <= 36% and in Table IV it is < 36%.
• The hematocrit cutoff is not different for males and females.
total score =
= SUM(points for all 15 parameters)
Interpretation:
• minimum score: 0
• maximum score: 33 (26 in study)
• The higher the score the greater the risk for unplanned readmission.
|
Score |
Risk Group |
Percent Readmission |
|
0 to 3 |
low |
5% |
|
4 to 7 |
intermediate |
9% |
|
>= 8 |
high |
16% |
When the data in Figure 1 is analyzed:
risk of readmission for scores from 0 to 26 =
= (0.0577 * ((points)^2)) + (0.334 * (points)) + 4.852
Purpose: To determine the risk for unplanned readmission for a patient followig vascular surgery based on the study of Iannuzzi et al.
Objective: risk factors, complications, surgery
ICD-10: I65, I66, I71, I72, I73.9, I83, I84, I85, I86,
