Predicting Major Postoperative In-Hospital Complications after Laparoscopic Cholecystectomy: A Simple Risk Score

 Melissa M. Murphy, MD, MPH, Shimul Shah, MD, Jessica P. Simons, MD, Nicholas G. Csikesz, BS, Sing-Chau Ng, MS 

Zheng Zhou MD, PhD, Jennifer F. Tseng, MD, MPH

Accepted for oral presentation at the Surgical Society of the Alimentray Tract (SSAT) Annual Meeting, Digestive Diseases Week (DDW), Chicago, IL, June 2009; manuscript submitted to Journal of Gastroinstinal Surgery

Step 1. Calculate Charlson comorbidity score
Indicate "yes" for the comorbidities that the patient has. This validated algorithm (Charlson, ME et al. J Chron Dis 1987; 40(5):373-83.) assigns a point value to the various diseases. The patient's raw score will then be reassigned into the collapsed Charlson score groups for use in the risk score calculation. Group 1 is a score of zero or 1, Group 2 is a score of 2, Group 3 is a score of 3 or higher.

 

Step 2. Calculate the risk score, including the Charlson group.
Patient sex, age, Charlson score group, presence of biliary tract inflammation (acute or chronic cholecystitis, cholangitis) or cancer, admission type, and hospital teaching status are indicated. The point values are assigned accordingly to yield an additive score. By clicking on the "Calculate Estimated Risk of Major Postoperative Complication" button, this score is then assigned to the appropriate risk score group, and the risk for that group is displayed. 

Previously validated major postoperative complications (Lawthers, AG et al. Med Care 2000; 38(8):785-95.) evaluated by the model include, postoperative infection, myocardial infarction, aspiration pneumonia, pulmonary compromise, gastrointestinal hemorrhage, reopening a surgical site, deep venous thrombosis/ pulmonary emobolism, and laceration/perforation.

Factor	Level	Point Value
Sex	Female Male
Age Group	<35 35- 64 >=65
Charlson Score
Biliary Tract Inflammation/Cancer	No Yes
Admission Type	Elective Emergent
Hospital Type	Teaching Non-teaching