Introduction: Predicting which patients will be successful with bariatric surgery has been, and is still being, elucidated; however, bariatric surgeons have not been able to predict which operation will be the most successful for a particular patient. We are seeking to quantify and qualify adult patients’ overall health using the Health Score as a measure of the severity and impact of comorbidities and lifestyle as they relate to perioperative risk, and more importantly, a successful surgical outcome. Although we will use this information as a component of the previously validated MORBID Score (pending publication) in bariatric surgery, it will be applicable to any surgical patient and can be used independently.
Methods: The Health Score has been created as the objective assessment of overall health and as part of the equation that calculates the MORBID Score. The Health Score was devised using the most relevant and current medical literature concerning the most common and impactful metabolic, cardiovascular, pulmonary, and lifestyle risks in order to quantify a patient’s health. There are sixteen components of the Health Score: blood pressure, BMI, cholesterol level, diabetes mellitus type II status, anemia, diet, exercise level, smoking, severity of obstructive sleep apnea, gastroesophageal reflux disease status, asthma, chronic obstructive pulmonary disease, cardiovascular disease, chronic kidney disease, quality of life, and mental health. In our review of the literature, the most common statistical method used to describe the magnitude of comorbidities was relative risk (RR). We ranked the RR of mortality as most important, followed by the RR of cardiovascular mortality, and then the RR of overall morbidity. Within each RR of mortality, cardiovascular morbidity, and overall morbidity, we also ordered the RR statistics from the shortest time period to the longest. If RR was not available, we employed odds or hazard ratio. We used these reported statistics to give individual scores to each of the sixteen components.
Results: The Health Score is an independent comorbidity and lifestyle risk and success assessment calculator. The final version of the Health Score is a computerized, user-friendly scale of 1-100, with the individual scores given to differing factors based on level of risk and relation to other factors as observed in medical literature. The user, whether primary care or specialist, is able to input a patient’s data and then receive information concerning further testing requirements, perioperative risk, and predicted success for any operation. It is also useful to gauge a patient’s overall health improvement throughout their long-term postoperative course.
Conclusions: The Health Score is a new tool that gives useful perioperative, and long-term postoperative information. However, this is a preliminary study that will occur in several stages. The next steps for the Health Score are analysis of surgical patients compared to healthy patients and validation of its usefulness in predicting perioperative risk and surgical success. The final step will be to input this data into the MORBID Score to predict which bariatric operation will be most successful for our patients.
Program Number: P074