Haga et al reported the Total Risk Points (TRP) score in patients undergong gastrointestinal surgery. This score correlates with the risk of anastomotic leak and in-hospital mortality. The authors are from the National Hospital Organization Kumamoto Medical Center and several other hospitals in Japan.
Parameters:
(1) age in years
(2) severe heart disease
(3) severe pulmonary disease
(4) diabetes mellitus
(5) performance status index of the Japanese Society for Cancer Therapy (which I assume is the same as the ECOG and WHO scale, from 0 to 4)
(6) ASA class (from 1 to 5)
(7) blood loss in grams per kg body weight
(8) operating time in hours
(9) extent of the skin incision
blood loss in grams per kg body weight =
= (blood loss in grams) / (body weight in kilograms)
|
Parameter
|
Finding
|
Points
|
|
heart disease
|
none
|
0
|
|
|
NYHA class I or II
|
0
|
|
|
NYHA class III or IV
|
300
|
|
|
severe arrhythmia
|
300
|
|
pulmonary disease
|
none
|
0
|
|
|
vital capacity >= 60% and FEV1 >= 50% of predicted
|
0
|
|
|
vital capacity < 60% or FEV1 < 50% of predicted
|
190
|
|
diabetes mellitus
|
absent
|
0
|
|
|
present
|
140
|
|
extent of skin incision
|
minor (including laparoscopic or thoracoscopic incisions)
|
0
|
|
|
laparotomy alone
|
340
|
|
|
thoracotomy alone
|
340
|
|
|
both laparotomy and thoracotomy
|
680
|
where:
• The density of whole blood is 1.055 grams per mL.
• Blood suctioned at surgery may be diluted with body fluids, crystalline solutions, etc.
TRP =
= (3 * (age in years)) + (160 * (performance status)) + (60 * (ASA class)) + (14 * (blood loss)) + (40 * (operative time in hours)) + SUM(points for the remaining 4 parameters))
Interpretation:
• The higher the TRP the greater the risk for anastomosis leak and for in-hospital mortality.
• The in-hospital mortality was significantly higher for patients with a TRP >= 1,000 (1% if < 1,000 and 16% if >= 1,000).
• The presence of performance status of 4 or an ASA class 5 would be good predictors of in-hospital mortality by themselves.
|
TRP
|
Anastomotic Leak Rate
|
|
< 500
|
1%
|
|
500 to 999
|
3%
|
|
1,000 to 1,499
|
5%
|
|
>= 1,500
|
14%
|
