Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program

A M Arozullah, J Daley, W G Henderson, S F Khuri, A M Arozullah, J Daley, W G Henderson, S F Khuri

Abstract

Objective: To develop and validate a preoperative risk index for predicting postoperative respiratory failure (PRF).

Summary background data: Respiratory failure is an important postoperative complication.

Method: Based on a prospective cohort study, cases from 44 Veterans Affairs Medical Centers (n = 81,719) were used to develop the models. Cases from 132 Veterans Affairs Medical Centers (n = 99,390) were used as a validation sample. PRF was defined as mechanical ventilation for more than 48 hours after surgery or reintubation and mechanical ventilation after postoperative extubation. Ventilator-dependent, comatose, do not resuscitate, and female patients were excluded.

Results: PRF developed in 2,746 patients (3.4%). The respiratory failure risk index was developed from a simplified logistic regression model and included abdominal aortic aneurysm repair, thoracic surgery, neurosurgery, upper abdominal surgery, peripheral vascular surgery, neck surgery, emergency surgery, albumin level less than 30 g/L, blood urea nitrogen level more than 30 mg/dL, dependent functional status, chronic obstructive pulmonary disease, and age.

Conclusions: The respiratory failure risk index is a validated model for identifying patients at risk for developing PRF and may be useful for guiding perioperative respiratory care.

References

    1. Wong DH, Weber EC, Schell MJ, et al. Factors associated with postoperative pulmonary complications in patients with severe chronic obstructive pulmonary disease. Anesth Analg 1995; 80: 276–284.
    1. Dales RE, Dionne G, Leech JA, Lunau M, Schweitzer I. Preoperative prediction of pulmonary complications following thoracic surgery. Chest 1993; 104: 155–159.
    1. Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest 1997; 111: 564–571.
    1. McCulloch TM, Jensen NF, Girod DA, Tsue TT, Weymuller EA. Risk factors for pulmonary complications in the postoperative head and neck surgery patient. Head and Neck 1997; 19: 372–377.
    1. Ondrula DP, Nelson RL, Prasad ML, Coyle BW, Abcarian H. Multifactorial index of preoperative risk factors in colon resections. Dis Colon Rectum 1992; 35: 117–122.
    1. Svensson LG, Hess KR, Coselli JS, Safi HJ, Crawford ES. A prospective study of respiratory failure after high-risk surgery on the thoracoabdominal aorta. J Vasc Surg 1991; 14: 271–282.
    1. Money SR, Rice K, Crockett D, et al. Risk of respiratory failure after repair of thoracoabdominal aortic aneurysms. Am J Surg 1994; 168: 152–155.
    1. Mitchell CK, Smoger SH, Pfeifer MP, et al. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg 1998; 133: 194—198.
    1. Calligaro KD, Azurin DJ, Dougherty MJ, et al. Pulmonary risk factors of elective abdominal aortic surgery. J Vasc Surg 1993; 18: 914–921.
    1. Kroenke K, Lawrence VA, Theroux JF, Tuley MR, Hilsenbeck S. Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease. Chest 1993; 104: 1445–1451.
    1. Ebert JP, Grimes B, Niemann KMW. Respiratory failure secondary to homologous blood transfusion. Anesthesiology 1985; 63: 104–106.
    1. Goldman L, Caldera DL, Nussbaum SR, et al. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med 1977; 297: 845–850.
    1. Palda VA, Detsky AS. Perioperative assessment and management of risk from coronary artery disease. Ann Intern Med 1997; 127: 313–328.
    1. Eagle KA, Brundage BH, Chaitman BR, et al. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery: an abridged version of the report of the American College of Cardiology/American Heart Association task force on practice guidelines. Mayo Clin Proc 1997; 72: 524–531.
    1. Khuri SF, Daley J, Henderson W, et al, for the National Veterans Administration Surgical Risk Study. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg 1995; 180: 519–531.
    1. Khuri SF, Daley J, Henderson W, et al, for the National Veterans Administration Surgical Risk Study. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185: 315–327.
    1. Daley J, Khuri SF, Henderson W, et al, for the National Veterans Administration Surgical Risk Study. Risk adjustment of the postoperative morbidity rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. J Am Coll Surg 1997; 185: 328–340.
    1. National Veterans Affairs Surgical Risk Adjustment Study, Non-Cardiac. Data Managers’ Terms, Definitions, Revised Sept. 5, 1991.
    1. Roberts JS, Capalbo GM. A SAS macro for estimating missing values in multivariate data. In: Proceedings of the 12th Annual SAS User Group International Conference, Feb. 8–11, 1987, Dallas, TX; 1987: 939–941.
    1. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270: 2957–2963.
    1. Lemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiology 1982; 115: 92–106.
    1. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982; 143: 29–36.
    1. Hall JC, Tarala RA, Hall JL, et al. A multivariate analysis of the risk of pulmonary complications after laparotomy. Chest 1991; 99: 923–927.
    1. Chumillas S, Ponce JL, Delgado F, Viciano V, Mateu M. Prevention of postoperative pulmonary complications through respiratory rehabilitation: a controlled clinical study. Arch Phys Med Rehabil 1998; 79: 5–9.
    1. Brooks-Brunn JA. Validation of a predictive model for postoperative pulmonary complications. Heart Lung 1998; 27: 151–158.
    1. Melendez JA, Carlon VA. Cardiopulmonary risk index does not predict complications after thoracic surgery. Chest 1998; 114: 69–75.

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