Rothman Index is a useful predictive tool for identifying patients likely to experience post-discharge adverse events

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Blood pressure is one of the components in calculating a patient's Rothman Index
Blood pressure is one of the factors used in calculating a patient’s Rothman Index. Credit: meddygarnet / Flickr.com CC BY 2.0

A retrospective review of patients who underwent elective spine surgery in New Haven, USA has shown that the Rothman Index (RI) may be used to predict adverse events following discharge. The authors, from Yale Medical School (New Haven, USA) and Wright State University (Dayton, USA), write that the measure “can help physicians identify high-risk patients … and should be able to better inform clinical decisions.”

The Rothman Index (Rothman Healthcare Corporation) is a software tool for mapping a patient patient’s overall health over time. It generates a ‘health score’ based on factors such as vital signs, lab values, nursing assessments and lab results. Previous research has demonstrated that a decrease in the index is a positive predictor of early surgical intensive care unit readmissions, and has outperformed other predictive tools in predicting patients likely to die within 24 hours.

The current study, an article-in-press published online in The Spine Journal, was a retrospective study examining over 2,600 patients over the period 2013 to 2016. Patient characteristics and postoperative outcomes at 30 days were considered, and events were classified as “major adverse events” or “minor adverse events”. Patient’s RI scores during hospitalisation were analysed and compared with their rate of adverse events after discharge.

“The latest and lowest RI values were significantly inversely correlated with any adverse events, major adverse events, minor adverse events and readmissions after controlling for age, sex, body mass index, American Society of Anesthesiologists class, surgical site, and hospital length of stay,” the authors say.

Patients with an RI score below 65 or a latest score below 85 were at increased risk of experiencing any adverse event or readmissions.

The researchers, including first author Ryan McLynn (Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, USA), conclude that the Rothman Index can be used to predict adverse events post-discharge following elective surgery, and will add value to other, commonly used indices.

The authors believe this to be the first study of the utility of the Rothman Index in spine surgery.

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