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.
Purpose: To identify the risk for readmission following a major hepatectomy using the score of Egger et al.
Specialty: Gastroenterology, Surgery, general, Surgery, orthopedic
Objective: risk factors, severity, prognosis, stage
ICD-10: C22, C23, D13.4, D13.5,