Mehta et al reported a comorbidity score for an older adult undergoing major surgery. This can help to identify a patient who may require more aggressive management. The authors are from the University of Texas Medical Branch in Galveston, University of Houston and University of Arizona.
Patient selection: prior to major surgery, age >= 65 years
|
Condition |
Points |
|
benign neoplasm |
-5 |
|
hyperlipidemia |
-4 |
|
nontraumatic joing disorders |
-4 |
|
alcohol-related disorders |
-3 |
|
joint injury |
-3 |
|
other bone diseases and musculoskeletal deformities |
-3 |
|
chest pain, nonspecific |
-2 |
|
diseases of female genital organs |
-2 |
|
diseases of male genital organs |
-2 |
|
genitourinary congenital anomalies |
-2 |
|
hemorrhoids |
-2 |
|
lower gastrointestinal disorders |
-2 |
|
miscellaneous mental health disorders |
-2 |
|
other circulatory disease |
-2 |
|
other connective tissue disorders |
-2 |
|
acquired deformities |
-1 |
|
eye disorder |
-1 |
|
history of mental health and substance abuse |
-1 |
|
occlusion or stenosis of precerebral arteries |
-1 |
|
osteoporosis |
-1 |
|
other inflammatory conditions of skin |
-1 |
|
other skin disorders |
-1 |
|
other upper respiratory disease |
-1 |
|
spondylosis, intervertebral disc disorders, other back problems |
-1 |
|
upper gastrointestinal disorders |
-1 |
|
cancer of urinary organs |
1 |
|
cancer, other primary |
1 |
|
cardiac dysrhythmia |
1 |
|
diabetes mellitus with complications |
1 |
|
fractures |
1 |
|
hereditary and degenerative nervous system condition |
1 |
|
late effects of cerebrovascular disease |
1 |
|
liver disease |
1 |
|
other nutritional, endocrine or metabolic disorders |
1 |
|
pleurisy, pneumothorax, pulmonary collapse |
1 |
|
pulmonary heart disease |
1 |
|
schizophrenia, psychosis |
1 |
|
superficial injury, contusion |
1 |
|
symptoms, signs, and ill-defined conditions |
1 |
|
acute cerebrovascular disease |
2 |
|
cancer of bronchus or lung |
2 |
|
conduction disorders |
2 |
|
diseases of the urinary system |
2 |
|
diseases of white blood cells |
2 |
|
fluid and electrolyte disorders |
2 |
|
gastrointestinal hemorrhage |
2 |
|
maintenance chemoradiotherapy |
2 |
|
open wound |
2 |
|
other gastrointestinal diseases |
2 |
|
pathological fracture |
2 |
|
peripheral and visceral atherosclerosis |
2 |
|
poisoning |
2 |
|
anemia |
3 |
|
cancer of lymphatic and hematopoietic tissue |
3 |
|
chronic ulcer of skin |
3 |
|
COPD or bronchiectasis |
3 |
|
malignant neoplasm without specified site |
3 |
|
mycoses |
3 |
|
respiratory failure, insufficiency, arrest |
3 |
|
other gastrointestinal cancer |
4 |
|
congestive heart failure, nonhypertensive |
5 |
|
delirium, dementia, amnesia, other cognitive disorders |
9 |
|
secondary malignancies |
9 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -48
• maximum score: 88
• The higher the score the greater the 1-year morality.
|
Total Score |
1-Year Mortality |
|
-30 to -15 |
3% |
|
-14 to -11 |
4% |
|
-9 or -10 |
5% |
|
-7 o r -8 |
7% |
|
-5 or -6 |
8% |
|
-2 or -4 |
10% |
|
-1 or 0 |
14% |
|
1 to 4 |
17% |
|
5 to 9 |
24% |
|
10 to 42 |
40% |
Performance:
• There is a chance for masking, with conditions scored negative covering major risk problems.
• The area under the ROC curve is 0.79.
