Margenthaler et al reported risk scores for complications following surgery for small bowel obstruction (SBO). One score predicts 30-day risk of morbidity. The authors are from Washington University, Yale University, St. Louis VA Medical Center, University of Colorado, Denver VA Medical Center, Harvard University and Brockton West Roxbury VA Medical Center.
Patient selection: surgery for small bowel obstruction (SBO)
Parameters:
(1) history of congestive heart failure (CHF)
(2) cerebrovascular accident with neurologic deficit
(3) history of COPD
(4) preoperative white blood cell count per microliter
(5) preoperative functional status
(6) surgery type
(7) preoperative serum creatinine in mg/dL
(8) wound classification
(9) ASA class
(10) age in decades
Parameter
Finding
Points
history of CHF
no
0
yes
6
history of CVA
no
0
yes
5
history of COPD
no
0
yes
5
preoperative WBC count
< 4,500 per µL
4
>= 4,500 per µL
0
functional status
independent
0
partially dependent
3
totally dependent
9
surgery type
adhesiolysis
0
small bowel resection
4
serum creatinine
<= 1.2 mg/dL
0
> 1.2 mg/dL
3
wound classification
clean
0
clean contaminated
2
dirty
7
infected
3
ASA class
1 or 2
0
3
4
4 or 5
5
age
< 50 years
0
50 to 59 years
2
60 to 69 years
1
70 to 79 years
4
>= 80 years
8
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 56
• The higher the score the greater the risk of postoperative complications.
Total Score
Class
Complication Rate
0 to 7
1
22%
8 to 10
2
26%
11 to 13
3
37%
14 to 18
4
47%
>= 19
5
62%
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