Davenport et al developed a score for predicting the risk of cardiac adverse events in a patient undergoing noncardiac surgery. The authors are from multiple hospitals in the United States participating in the Patient Safety in Surgery study which involved Veterans Affairs hospitals and the American College of Surgery..
Adverse cardiac events included:
(1) acute myocardial infarction
(2) cardiac arrest with cardiopulmonary resuscitation
Parameters:
(1) ASA status
(2) work RVU (relative value unit) of most complex procedure
(3) emergency surgery
(4) preoperative creatinine
(5) age of the patient in years
(6) preoperative sepsis
(7) preoperative bleeding disorder
(8) preoperative weight loss
(9) preoperative congestive heart failure (within prior 30 days)
(10) type of operation
(11) WBC count
(12) preoperative platelet count
(13) impaired sensorium
(14) dyspnea
(15) stroke with neurologic deficit
(16) ascites
(17) wound class
(18) preoperative albumin
(19) gender
(20) specialty
|
Parameter |
Finding |
Points |
|---|---|---|
|
ASA status |
1 or 2 |
0 |
|
|
3 |
3 |
|
|
4 or 5 |
6 |
|
work RVU |
< 10 |
0 |
|
|
10 to 17 |
2 |
|
|
> 17 |
3 |
|
emergency surgery |
no |
0 |
|
|
yes |
2 |
|
preoperative creatinine |
< 1.5 mg/dL |
0 |
|
|
>= 1.5 mg/dL |
2 |
|
age of the patient in years |
< 40 years of age |
0 |
|
|
40 to 65 years of age |
3 |
|
|
> 65 years of age |
5 |
|
preoperative sepsis |
no |
0 |
|
|
yes |
2 |
|
preoperative bleeding disorder |
no |
0 |
|
|
yes |
1 |
|
preoperative weight loss |
no |
0 |
|
|
yes |
2 |
|
preoperative CHF |
no |
0 |
|
|
yes |
2 |
|
type of operation |
endocrine |
0 |
|
|
mouth or palate |
3 |
|
|
thoracoabdominal aneurysm |
3 |
|
|
peripheral aneurysm |
3 |
|
|
stomach or intestinal |
3 |
|
|
respiratory and hemic |
3 |
|
|
skin |
3 |
|
|
hernia |
1 |
|
preoperative WBC count |
2,500 to 10,000 per µL |
0 |
|
|
< 2,500 per µL |
1 |
|
|
> 10,000 per µL |
2 |
|
preoperative platelet count |
> 150,000 per µL |
0 |
|
|
<= 150,000 per µL |
1 |
|
impaired sensorium |
no |
0 |
|
|
yes |
1 |
|
dyspnea |
no |
0 |
|
|
yes |
1 |
|
stroke with neurologic deficit |
no |
0 |
|
|
yes |
1 |
|
ascites |
no |
0 |
|
|
yes |
2 |
|
wound class |
clean |
0 |
|
|
contaminated |
1 |
|
|
clean/contaminated |
1 |
|
|
infected |
1 |
|
preoperative albumin |
> 3.5 g/dL |
0 |
|
|
<= 3.5 g/dL |
1 |
|
gender |
female |
0 |
|
|
male |
1 |
|
specialty (of surgeon) |
general |
0 |
|
|
vascular |
1 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 40
• The higher the score the greater the risk of an adverse cardiac event.
|
Total Score |
Risk of an Adverse Cardiac Event |
|---|---|
|
< 9 |
< 1% |
|
9 to 16 |
(0.1882 * (score)) - 1.735 |
|
16 to 28 |
(0.08014 * ((score)^2)) - (2.25 * (score)) + 16.97 |
|
28 to 30 |
(1.25 * (score)) - 15.45 |
|
> 30 |
> 22% |
Purpose: To predict the risk of an adverse cardiac event following noncardiac surgery using the score of Davenport et al.
Specialty: Cardiology, Surgery, general, Surgery, orthopedic
Objective: risk factors, severity, prognosis, stage, adverse effects
ICD-10: I20-I25, I50,
