A risk prediction model for mortality in the moribund general surgical patient. J Crit Care 2015 Apr;30(2):310-4
Date
12/17/2014Pubmed ID
25499416DOI
10.1016/j.jcrc.2014.11.012Scopus ID
2-s2.0-84923093454 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
INTRODUCTION: Surgeons struggle to counsel families on the role of surgery and likelihood of survival in the moribund patient. We sought to develop a risk prediction model for postoperative inpatient death for the moribund surgical candidate.
MATERIALS AND METHODS: Using 2007-2012 American College of Surgeons National Surgical Quality Improvement Program data, we identified American Society of Anesthesiologists class 5 (moribund) patients. The sample was randomly divided into development and validation cohorts. In the development cohort, preoperative patient characteristics were evaluated. The primary outcome measure was in-hospital mortality. Factors significant in univariate analysis were entered into a multivariable model; points were assigned based on β coefficients. A scoring system was generated to predict inpatient mortality. Models were developed separately for operations performed within and after 24 hours of admission, and tested on the validation cohort.
RESULTS: A total of 3120 patients were included. In-hospital mortality was 50.6%. In multivariable analysis, patient characteristics associated with in-hospital mortality were age, functional status, recent dialysis, recent myocardial infarction, ventilator dependence, body mass index, and procedure type. The scoring system generated from this model accurately predicted in-hospital mortality for patients undergoing surgery within and after 24 hours.
CONCLUSION: A simple risk prediction model using readily available preoperative patient characteristics accurately predicts postoperative mortality in the moribund surgical patient. This scoring system can assist in decision making.
Author List
Kuo LE, Simmons KD, Holena DN, Karakousis G, Kelz RRAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Aged, 80 and over
Cohort Studies
Critical Illness
Decision Support Techniques
Female
Hospital Mortality
Humans
Male
Middle Aged
Postoperative Complications
Quality Improvement
Retrospective Studies
Risk
Risk Assessment
Risk Factors
Surgical Procedures, Operative
Young Adult
