Tejwani et al reported a comorbidity score for pediatric patients undergoing inpatient surgery. This is associated with the risk of postoperative complications. The authors are from Duke University.
Patient selection: pediatric (age < 18 years) undergoing inpatient surgery
Parameters:
(1) age in years
(2) surgery type
(3) chronic renal failure, chronic renal insufficiency, end-stage renal disease
(4) cystic fibrosis
(5) inborn error of metabolism
(6) ongoing oxygen requirement
(7) low birth weight (prematurity)
(8) malnutrition, eating disorder, feeding disorder
(9) congenital heart disease
(10) cardiac arrhythmia
(11) obesity (body weight > 95th percentile)
(12) hypertension (blood pressure over 120/80)
(13) influenza
(14) pneumonia
(15) asthma, reactive airway disease, bronchopulmonary dysplasia
(16) urinary tract infection, chronic pyelonephritis
(17) coagulation defect
(18) mental disorder, psychiatric illness
(19) scoliosis, vertebral anomaly
(20) gastroparesis, gastric motility disorder
(21) failure to thrive
(22) history of cancer, tumor, leukemia
(23) autoimmune disorder, vasculitis, inflammatory bowel disease
|
Parameter |
Finding |
Points |
|
age |
0 to 1 (infancy) |
3 |
|
|
2 to 3 years |
2 |
|
|
4 to 6 years |
0 |
|
|
7 to 12 years |
-1 |
|
|
>= 13 years |
0 |
|
surgery type |
general surgery |
0 |
|
|
cardiothoracic |
16 |
|
|
ENT |
5 |
|
|
multiple surgeries |
5 |
|
|
neurosurgery |
0 |
|
|
obstetrics |
-6 |
|
|
orthopedics |
1 |
|
|
urology |
0 |
|
CKD, ESRD |
no |
0 |
|
|
yes |
9 |
|
cystic fibrosis |
no |
0 |
|
|
yes |
8 |
|
inborn error metabolism |
no |
0 |
|
|
yes |
2 |
|
ongoing oxygen requirement |
no |
0 |
|
|
yes |
20 |
|
low birth weight, prematurity |
no |
0 |
|
|
yes |
-1 |
|
malnutrition |
no |
0 |
|
|
yes |
-2 |
|
congenital heart disease |
no |
0 |
|
|
yes |
6 |
|
cardiac arrhythmia |
no |
0 |
|
|
yes |
2 |
|
obesity |
no |
0 |
|
|
yes |
-1 |
|
hypertension |
no |
0 |
|
|
yes |
2 |
|
influenza |
no |
0 |
|
|
yes |
3 |
|
pneumonia |
no |
0 |
|
|
yes |
6 |
|
asthma, RAD, bronchopulmonary dysplasia |
no |
0 |
|
|
yes |
-1 |
|
UTI, chronic pyelonephritis |
no |
0 |
|
|
yes |
7 |
|
coagulation defect |
no |
0 |
|
|
yes |
10 |
|
mental disorder, psychiatric illness |
no |
0 |
|
|
yes |
1 |
|
scoliosis, vertebral anomaly |
no |
0 |
|
|
yes |
2 |
|
gastroparesis, gastric motility disorder |
no |
0 |
|
|
yes |
-2 |
|
failure to thrive |
no |
0 |
|
|
yes |
-2 |
|
history cancer, tumor, leukemia |
no |
0 |
|
|
yes |
3 |
|
autoimmune disorder |
no |
0 |
|
|
yes |
2 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -16
• maximum score: 102
• The higher the score the higher the risk of postoperative complications.
|
Score |
Percent Surgical Complications |
|
-3 |
5% |
|
2 |
20% |
|
9-11 |
40% |
|
18 |
60% |
|
31-40 |
80% |
|
> 40 |
90% |
from Figure 1(A).
Performance:
• The area under the ROC curve is 0.76.
