Ballian et al developed scores for evaluating patients undergoing surgical repair of a giant paraesophageal hernia. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Pittsburgh.
Patient selection: laparoscopic repair of a giant paraesophageal hernia
Parameters:
(1) age in years
(2) congestive heart failure
(3) pulmonary disease
(4) type of surgery
(5) gender
|
Parameter |
Finding |
Points for Mortality |
|
age of the patient |
< 80 years |
0 |
|
|
>= 80 years |
9 |
|
congestive heart failure |
absent |
0 |
|
|
present |
5 |
|
pulmonary disease |
absent |
0 |
|
|
present |
3 |
|
surgery type |
urgent or emergent |
3 |
|
|
elective |
0 |
score for mortality =
= SUM(points for all 4 parameters)
|
Parameter |
Finding |
Points for Morbidity |
|
gender of the patient |
femael |
0 |
|
|
male |
1 |
|
age of the patient |
< 50 years |
0 |
|
|
50 to 59 years |
1 |
|
|
60 to 79 years |
2 |
|
|
>= 80 years |
3 |
|
congestive heart failure |
absent |
0 |
|
|
present |
4 |
|
pulmonary disease |
absent |
0 |
|
|
present |
2 |
|
surgery type |
urgent or emergent |
2 |
|
|
elective |
0 |
score for morbidity = =
= SUM(points for all 5 parameters)
Interpretation:
• minimum morbidity and mortality scores: 0
• maximum mortality score: 20
• maximum morbidity score: 12
• The higher the scores the greater the risk.
|
Score for Mortality |
Risk Group |
Mortality |
|
0 to 2 |
low |
0.2% |
|
3 |
intermediate |
0.7% |
|
4 to 20 |
high |
9.3% |
|
Score for Morbidity |
Risk Group |
>= 1 Major Adverse Event |
|
0 to 2 |
minimal |
14% |
|
3 |
low |
20% |
|
4 |
intermediate |
26% |
|
5 to 12 |
high |
41% |
Performance:
• The area under the ROC curve for morbidity was 0.68.
• The discriminatory accuracy for mortality was 88%.
Specialty: Anesthesiology, Gastroenterology, Surgery, general
