ObjectiveTo develop and validate a preoperative risk index for predicting postoperative respiratory failure (PRF).
Summary Background DataRespiratory failure is an important postoperative complication.
MethodBased on a prospective cohort study, cases from 44 Veterans Affairs Medical Centers (n ϭ 81,719) were used to develop the models. Cases from 132 Veterans Affairs Medical Centers (n ϭ 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.
ResultsPRF 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.
ConclusionsThe 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.Postoperative pulmonary complications greatly contribute to the death and complication rates of surgery. It has been reported that 5% to 10% of all surgical patients and 9% to 40% of those undergoing abdominal surgery experience postoperative pulmonary complications.
The postoperative pneumonia risk index identifies patients at risk for postoperative pneumonia and may be useful in guiding perioperative respiratory care.
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