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Lap Partial Nephrectomy Intra or Post-op Bleeding Nomogram
Palm TM Version
Designed by: Sijo J. Parekattil, Michael W. Kattan, and Inderbir S. Gill.
Introduction and Objective: Bleeding during and after Laparoscopic Partial Nephrectomy (LPN) can be a serious complication. Our goal was to create a nomogram to pre-operatively predict which patients are more likely to bleed. This would allow for patient counseling and preoperative planning.
Methods: Retrospective review of 371 consecutive LPNs from September 1999 to September 2004. Three predictors were evaluated: patient age, size of tumor (in cm by CT evaluation), and pre-operative serum creatinine. The outcome being predicted was intra-operative bleeding (>400cc blood) or any post-operative bleeding (requiring transfusion, re-exploration or hematoma on CT). A logistic regression model was constructed to predict the probability of having an intra-operative or post-operative bleed.
Results: The overall combined intra-op and post-op bleed rate was 12.6% in the 371 cases. The model had a bootstrap-corrected area under the receiver operating characteristic curve of 0.6. The model was well calibrated except when predicting a bleeding probability of above 18% and thus, this was defined as the upper limit of its prediction capability.
Conclusions: Our model has a fair accuracy (ROC 0.6) in predicting the probability of bleeding during or after a Laparoscopic Partial Nephrectomy. This model may be utilized in preoperative patient counseling and operative planning. Further testing and development will allow for refinement of the model and incorporation of other predictors.
Download Instructions: Click on the link below to download the program. If you download the file onto the computer which is used to synchornize with your device, the installer program will automatically initiate once you click on the file after it is downloaded.
This software is only intended for research and development purposes. It is to be used only by physicians, residents in training or medical students.
THIS PROGRAM IS PROVIDED "AS IS" AND WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, WARRANTY OF MERCHANTABILITY , FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT OR FREEDOM FROM VIRUSES OR OTHER CODE DEFECTS. THE AUTHOR EXPRESSLY DISCLAIMS LIABILITY FOR ERRORS OR OMISSIONS IN THE PROGRAM. IN NO EVENT SHALL THE AUTHOR BE LIABLE FOR DAMAGES OF ANY KIND, INCLUDING WITHOUT LIMITATION, DIRECT OR INDIRECT, SPECIAL, INCIDENTAL OR CONSEQUENTIAL DAMAGES, CLAIMS, LOSSES OR EXPENSES (WHETHER IN TORT, CONTRACT OR OTHERWISE) ARISING OUT OF OR IN CONNECTION WITH THE USE OF THIS PROGRAM.
No part of this program may be copied or otherwise reproduced in any way without express written consent from the author: Sijo J. Parekattil, M.D.
By downloading the following program, the user accepts the above terms and conditions of use.
The following program requires Mathlib to be loaded on your Palm device. If you do not have this, click here to obtain a free shareware copy of Mathlib.
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