Patient selection: laparoscopic repair of a giant paraesophageal hernia
Outcome: morbidity (pneumonia, reintubation, postoperative tracheostomy, pulmonary embolism, myocardial infarction, congestive heart failure, acute renal failure, stroke, sepsis, operative site leak, hernia recurrence, readmission, reoperation)
Parameters:
(1) congestive heart failure
(2) pulmonary disease
(3) surgical acuity
(4) age of the patient in years
(5) sex
|
Parameter
|
Finding
|
Points
|
|
congestive heart failure
|
absent
|
0
|
|
|
present
|
4
|
|
pulmonary disease
|
absent
|
0
|
|
|
present
|
2
|
|
surgical acuity
|
elective
|
0
|
|
|
nonelective
|
2
|
|
age of the patient
|
< 50 years
|
0
|
|
|
50 to 59 years
|
1
|
|
|
60 to 79 years
|
2
|
|
|
>= 80
|
3
|
|
sex
|
female
|
0
|
|
|
male
|
1
|
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the morbidity.
|
Total Score
|
Risk Group
|
At least 1 major adverse outcome
|
|
0 to 2
|
minimal
|
13.5%
|
|
3
|
low
|
19.7%
|
|
4
|
intermediate
|
26.1%
|
|
5 to 12
|
high
|
40.6%
|
Performance:
• The area under the ROC curve is 0.678.
