Weed et al identified preoperative risk factors associated with postoperative delirium following major head and neck surgery for cancer. These can help identify patients who may benefit from closer monitoring and who are at greater risk for postoperative complications. The authors are from the Ohio State University.
NOTE: The parameters are very similar to that of Marcantonio et al (above).
Parameters:
(1) age
(2) history of alcohol abuse (more than 2 drinks per day)
(3) cognitive status based on the Folstein Mini-Mental State (MMS, scores 0 to 30, see Chapter 18)
(4) functional status based on the Specific Activity Scale (SAS, class 1 to 4)
(5) serum chemistries (sodium, potassium, glucose)
|
Parameter |
Finding |
Points |
|
age of the patient |
< 70 years of age |
0 |
|
|
>= 70 years of age |
1 |
|
history of alcohol abuse |
absent |
0 |
|
|
present |
1 |
|
cognitive status |
excellent to fair (MMS > 24) |
0 |
|
|
poor (MMS <= 24) |
1 |
|
functional status |
excellent to fair |
0 |
|
|
poor (SAS class 4) |
1 |
|
serum chemistries |
not markedly abnormal |
0 |
|
|
markedly abnormal |
1 |
where:
• Markedly abnormal serum chemistries involved one or more of the following: sodium < 130 mmol/L, sodium > 150 mmol/L, potassium < 3 mmol/L, potassium > 6 mmol/L, glucose < 60 mg/dL, glucose > 300 mg/dL.
• Glucose was not specified as serum or whole blood.
• A person with SAS class 4 functional status is unable to dress self or make the bed without stopping or is unable to walk 1 block at a pace of 4 km per hour.
• The p values on chi-squared test ranged from 0.066 to 0.561 (univariate analysis).
total risk score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum total risk score: 0
• maximum total risk score: 5
• The higher the risk score the greater the risk of postoperative delirium.
|
Total Risk Score |
Risk Group |
Probability of Delirium |
|
0 |
very low |
< 2% |
|
1 |
low |
9% |
|
2 |
medium |
19% |
|
3 to 5 |
high |
25% |
Specialty: Anesthesiology, Neurology, Surgery, orthopedic
