Prediction of postoperative pulmonary complications in a population-based surgical cohort
Jaume Canet, Lluís Gallart, Carmen Gomar, Guillem Paluzie, Jordi Vallès, Jordi Castillo, Sergi Sabaté, Valentín Mazo, Zahara Briones, Joaquín Sanchis, ARISCAT Group, Carme Font, Meritxell Sabria, Anna Font, Encarna Subirana, Carme Jandula, Albert Canadell, Pere Esquius, Irene Rosell, Lourdes Abellan, Julio Meza, Sergi Viedma, Jordi Guitart, Roberto Climent, Luis Sarmiento, Lluís Oduber, Horacio Agustín Pena, Mirtza Gutierrez, Francisco Cedo, Carme Colls, Victoria Moral, Campos Juan Manuel, Ana Gonzalez, Alfredo Merten, Jose Fernandez, Lucía Hernandez, Mar Gonzalez, Adria Font, Nuria Isach, Teresa Vilalta, Victor Espiga, Gracia Cardenas, Merce Prieto, Farid Hobeich, Joaquim Hernandez, Xavier Fargas, Anna Vidal, Josep Canudas, Pilar Sierra, Ana Arnal, Pilar Baxarias, Pere Casanovas, Guillermo Pena, Manuel Roig, Josep Genís, Josep M Bausili, Irene Rovira, Amalia Alcon, Teresa Anglada, Anna Lopez, Jose Carretero, Roger Pujol, Antonio Ojeda, M Teresa Ballester, Julio Llorens, Francisco Javier Belda, Miguel Angel Gil, Montserrat Raventos, Enric Turon, Teresa Aberasturi, Ariadna Tuya, Javier Martínez, Antoni Vila, Xavier Bosch, Ricard Masia, Sonia Mateo, Robert Masip, Carles Montoy, Enric Manubens, Cesar Jaramillo, Antonio Villalonga, Berta Pardina, Anna Costa, Jose Sanchez, Olga Pineda, Carmen Hernandez, Montserrat Bayo, Joan Coma, Lydia Buisan, Isabel Cabre, Lluïsa Opisso, Yolanda Jimenez, Nerea Sanchís, A Tomas Esteban, Manel Jimenez, Carmen Colilles, Nuria Guilera, Elisabeth Hansen, Carmen Díaz, Jordi Torrellardona, Dolors Molies, Rosa M Tarradell, Anna Serra, Raul Benlloch, M Pilar Roca, Nestor Jarma, Carmen Martín, Pilar Moragriega, Giacomo Ledda, M Jose Linares, Elisenda Izquierdo, Francisco Nebot, Antonio Chamero, Jose Sanchez, Josep Masdeu, Jose Antonio Villanueva, Jose Miguel Moncho, Hector Oreiro, Rodrigo Galan, Onel Morales, Julian Roldan, Pilar Santos, Demetrio Mulas, Elena Hernando, Teresa Planella, Jordi Serrat, Silvia Cardoner, Lluís Aguilera, Xavier Santiveri, Fernando Escolano, Rosario Armand-Ugon, Lucía Valencia, Monica Williams, Amelia Rojo, M Dolors Sintes, Lluis Martinez, Fernando Rey, Jesus Antonio Martínez, Francisco Eugenio Fontao, Monica Perez, Juan Ortega, Marta Lopez, Jose Bernal, Carme Perez, Josep M Corominas, Patricia Conde, Carlos Castro, Lluís Munoz, Albert Codina, Rosa Urday, Benet Casagran, Julio Cesar Paredes, Montserrat Torra, Rosa M Urgell, M Paz Villalba, M Dolors del Pozo, Tomas Martínez, Jose Luis Gomez, Rafael Gonzalez, Herminio Obon, Antonio Montero, Lucía García Huete, Eva Digon, Ana Cabrera, Teresa Alcazar, Víctor Mayoral, Ana Belen Pedregosa, Roser Torruella, Federico Gregorio Carol, Jesus Cuenca, Pilar Prieto, Susana Bella, María Rull, Benjamín Solsona, Ione Montalvo, Silvia Coves, Barbara Mendez, M Teresa Sarinena, Monica Rodríguez, Esther Vila, Agnes Martí, Alfonso Rengel, Susana Munoz, Vicente De Sanctis, Isabel Arias, Manuel Mateo, Jaume Roige, Rosa Sala, Patricia Bascunana, Anna Rodriguez, Elena Serrano, Montserrat Ribas, Pilar Cortiella, Javier Medel, Esther Marquez, Inmaculada Salgado, Carmelo Lozano, Antoni Serrat, Carlos Morros, Dolores Perez, Josep M Serra, Juan Pablo Lorenzo, Jaume Canet, Lluís Gallart, Carmen Gomar, Guillem Paluzie, Jordi Vallès, Jordi Castillo, Sergi Sabaté, Valentín Mazo, Zahara Briones, Joaquín Sanchis, ARISCAT Group, Carme Font, Meritxell Sabria, Anna Font, Encarna Subirana, Carme Jandula, Albert Canadell, Pere Esquius, Irene Rosell, Lourdes Abellan, Julio Meza, Sergi Viedma, Jordi Guitart, Roberto Climent, Luis Sarmiento, Lluís Oduber, Horacio Agustín Pena, Mirtza Gutierrez, Francisco Cedo, Carme Colls, Victoria Moral, Campos Juan Manuel, Ana Gonzalez, Alfredo Merten, Jose Fernandez, Lucía Hernandez, Mar Gonzalez, Adria Font, Nuria Isach, Teresa Vilalta, Victor Espiga, Gracia Cardenas, Merce Prieto, Farid Hobeich, Joaquim Hernandez, Xavier Fargas, Anna Vidal, Josep Canudas, Pilar Sierra, Ana Arnal, Pilar Baxarias, Pere Casanovas, Guillermo Pena, Manuel Roig, Josep Genís, Josep M Bausili, Irene Rovira, Amalia Alcon, Teresa Anglada, Anna Lopez, Jose Carretero, Roger Pujol, Antonio Ojeda, M Teresa Ballester, Julio Llorens, Francisco Javier Belda, Miguel Angel Gil, Montserrat Raventos, Enric Turon, Teresa Aberasturi, Ariadna Tuya, Javier Martínez, Antoni Vila, Xavier Bosch, Ricard Masia, Sonia Mateo, Robert Masip, Carles Montoy, Enric Manubens, Cesar Jaramillo, Antonio Villalonga, Berta Pardina, Anna Costa, Jose Sanchez, Olga Pineda, Carmen Hernandez, Montserrat Bayo, Joan Coma, Lydia Buisan, Isabel Cabre, Lluïsa Opisso, Yolanda Jimenez, Nerea Sanchís, A Tomas Esteban, Manel Jimenez, Carmen Colilles, Nuria Guilera, Elisabeth Hansen, Carmen Díaz, Jordi Torrellardona, Dolors Molies, Rosa M Tarradell, Anna Serra, Raul Benlloch, M Pilar Roca, Nestor Jarma, Carmen Martín, Pilar Moragriega, Giacomo Ledda, M Jose Linares, Elisenda Izquierdo, Francisco Nebot, Antonio Chamero, Jose Sanchez, Josep Masdeu, Jose Antonio Villanueva, Jose Miguel Moncho, Hector Oreiro, Rodrigo Galan, Onel Morales, Julian Roldan, Pilar Santos, Demetrio Mulas, Elena Hernando, Teresa Planella, Jordi Serrat, Silvia Cardoner, Lluís Aguilera, Xavier Santiveri, Fernando Escolano, Rosario Armand-Ugon, Lucía Valencia, Monica Williams, Amelia Rojo, M Dolors Sintes, Lluis Martinez, Fernando Rey, Jesus Antonio Martínez, Francisco Eugenio Fontao, Monica Perez, Juan Ortega, Marta Lopez, Jose Bernal, Carme Perez, Josep M Corominas, Patricia Conde, Carlos Castro, Lluís Munoz, Albert Codina, Rosa Urday, Benet Casagran, Julio Cesar Paredes, Montserrat Torra, Rosa M Urgell, M Paz Villalba, M Dolors del Pozo, Tomas Martínez, Jose Luis Gomez, Rafael Gonzalez, Herminio Obon, Antonio Montero, Lucía García Huete, Eva Digon, Ana Cabrera, Teresa Alcazar, Víctor Mayoral, Ana Belen Pedregosa, Roser Torruella, Federico Gregorio Carol, Jesus Cuenca, Pilar Prieto, Susana Bella, María Rull, Benjamín Solsona, Ione Montalvo, Silvia Coves, Barbara Mendez, M Teresa Sarinena, Monica Rodríguez, Esther Vila, Agnes Martí, Alfonso Rengel, Susana Munoz, Vicente De Sanctis, Isabel Arias, Manuel Mateo, Jaume Roige, Rosa Sala, Patricia Bascunana, Anna Rodriguez, Elena Serrano, Montserrat Ribas, Pilar Cortiella, Javier Medel, Esther Marquez, Inmaculada Salgado, Carmelo Lozano, Antoni Serrat, Carlos Morros, Dolores Perez, Josep M Serra, Juan Pablo Lorenzo
Abstract
Background: Current knowledge of the risk for postoperative pulmonary complications (PPCs) rests on studies that narrowly selected patients and procedures. Hypothesizing that PPC occurrence could be predicted from a reduced set of perioperative variables, we aimed to develop a predictive index for a broad surgical population.
Methods: Patients undergoing surgical procedures given general, neuraxial, or regional anesthesia in 59 hospitals were randomly selected for this prospective, multicenter study. The main outcome was the development of at least one of the following: respiratory infection, respiratory failure, bronchospasm, atelectasis, pleural effusion, pneumothorax, or aspiration pneumonitis. The cohort was randomly divided into a development subsample to construct a logistic regression model and a validation subsample. A PPC predictive index was constructed.
Results: Of 2,464 patients studied, 252 events were observed in 123 (5%). Thirty-day mortality was higher in patients with a PPC (19.5%; 95% [CI], 12.5-26.5%) than in those without a PPC (0.5%; 95% CI, 0.2-0.8%). Regression modeling identified seven independent risk factors: low preoperative arterial oxygen saturation, acute respiratory infection during the previous month, age, preoperative anemia, upper abdominal or intrathoracic surgery, surgical duration of at least 2 h, and emergency surgery. The area under the receiver operating characteristic curve was 90% (95% CI, 85-94%) for the development subsample and 88% (95% CI, 84-93%) for the validation subsample.
Conclusion: The risk index based on seven objective, easily assessed factors has excellent discriminative ability. The index can be used to assess individual risk of PPC and focus further research on measures to improve patient care.
Source: PubMed