Tejwani et al reported a comorbidity score for pediatric patients undergoing ambulatory surgery. This is associated with the risk of postoperative complications. The authors are from Duke University
Patient selection: pediatric (age < 18 years) undergoing ambulatory surgery
Parameters:
(1) age in years
(2) surgery type
(3) chronic renal failure, chronic renal insufficiency, end-stage renal disease
(4) inborn error of metabolism
(5) ongoing oxygen requirement
(6) low birth weight (prematurity)
(7) malnutrition, eating disorder, feeding disorder
(8) congenital heart disease
(9) cardiac arrhythmia
(10) obesity (body weight > 95th percentile)
(11) hypertension (blood pressure over 120/80)
(12) influenza
(13) pneumonia
(14) sleep apnea or obstructive airway
(15) urinary tract infection, chronic pyelonephritis
(16) scoliosis, vertebral anomaly
(17) gastroparesis, gastric motility disorder
(18) failure to thrive
(19) spina bifida, Chiari malformation, spinal cord injury, structural CNS abnormality
|
Parameter |
Finding |
Points |
|
age |
0 to 1 (infancy) |
-3 |
|
|
2 to 12 |
0 |
|
|
13 to 17 (teenager) |
1 |
|
surgery type |
general surgery |
0 |
|
|
cardiothoracic |
8 |
|
|
ENT |
2 |
|
|
multiple surgeries |
1 |
|
|
neurosurgery |
1 |
|
|
obstetrics |
1 |
|
|
orthopedics |
-3 |
|
|
urology |
4 |
|
CKD, ESRD |
no |
0 |
|
|
yes |
3 |
|
inborn error metabolism |
no |
0 |
|
|
yes |
1 |
|
ongoing oxygen requirement |
no |
0 |
|
|
yes |
7 |
|
low birth weight, prematurity |
no |
0 |
|
|
yes |
2 |
|
malnutrition |
no |
0 |
|
|
yes |
1 |
|
congenital heart disease |
no |
0 |
|
|
yes |
2 |
|
cardiac arrhythmia |
no |
0 |
|
|
yes |
1 |
|
obesity |
no |
0 |
|
|
yes |
1 |
|
hypertension |
no |
0 |
|
|
yes |
2 |
|
influenza |
no |
0 |
|
|
yes |
1 |
|
pneumonia |
no |
0 |
|
|
yes |
1 |
|
sleep apnea, obstructive |
no |
0 |
|
|
yes |
4 |
|
UTI, chronic pyelonephritis |
no |
0 |
|
|
yes |
3 |
|
scoliosis, vertebral anomaly |
no |
0 |
|
|
yes |
2 |
|
gastroparesis, gastric motility disorder |
no |
0 |
|
|
yes |
1 |
|
failure to thrive |
no |
0 |
|
|
yes |
1 |
|
spina bifida, Chiari, etc |
no |
0 |
|
|
yes |
2 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -6
• maximum score: 44
• The higher the score the higher the risk of postoperative complications.
|
Score |
Percent Surgical Complications |
|
0 |
5% |
|
4 and 5 |
10% |
|
7 |
15% |
|
10 |
20% |
|
11 |
30% |
|
> 11 |
40% |
from Figure 1(B).
Performance:
• The area under the ROC curve is 0.68.
