Description

Egger et al developed a score for predicting risk of readmission following major hepatectomy. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Louisville, Emory University, and the University of Wisconsin.


Patient selection: status post major hepatectomy

 

Parameters:

(1) estimated blood loss in mL

(2) postoperative red blood cell transfusion

(3) complications

(4) maximum postoperative total serum bilirubin in mg/dL

(5) surgical site infection (wound and/or intra-abdominal)

(6) postoperative pulmonary embolism

 

Parameters

Findings

Points

estimated blood loss

< 500 mL

0

 

500 to 1,000 mL

3

 

> 1,000 mL

6

postoperative blood transfusion

no

12

 

yes

0

complications

none

0

 

minor (Clavien-Dindo Class 1 or 2)

15

 

major (Clavien-Dindog Class 3 or higher)

33

maximum peak total serum bilirubin

< 2.0 mg/dL

0

 

2.0 to 2.9 mg/dL

2

 

3.0 to 3.9 mg/dL

3

 

4.0 to 4.9 mg/dL

5

 

5.0 to 5.9 mg/dL

6

 

>= 6.0 mg/dL

7

surgical site infection

no

0

 

yes

17

postoperative pulmonary embolism

no

0

 

yes

26

 

where:

• Surgical site infection and pulmonary embolism are not scored as complications in the implementation.

 

total score =

= SUM(points for all 6 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 101

• The higher the score the greater the risk for readmission.

 

Score

Risk Group

Readmission Rate

<= 20

low

4.4%

21 to 50

intermediate

24%

>= 51

high

51%

 

Performance:

• The area under the ROC curve is 0.81.


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