Acute fibrinous and organizing pneumonia (AFOP) is a rare histologic interstitial pneumonia pattern recently described in the literature with fewer than 120 cases published. AFOP is often difficult to diagnose and may be mistaken for other pulmonary disorders such as interstitial pneumonias or pneumonitides. Patients often present with vague symptoms of cough, dyspnea, hemoptysis, fatigue, and occasionally respiratory failure. Radiological findings show diffuse patchy opacities and ground glass appearance of the lungs. On histologic examination, intra-alveolar fibrin balls are observed. We discuss a case of a man who presented with hemoptysis and dyspnea and whose open lung biopsy revealed AFOP. We will describe the presentation, diagnosis, and post-discharge course, and review the current literature. There are only 4 cases which have reported the patients' course of disease after 1 year, the longest being 2 years. To our knowledge, this is the only case of AFOP in the literature that describes the course of a patient more than 2 years after the diagnosis of AFOP, and is the most comprehensive review of the current literature.
Background
Current preoperative assessment tools such as the American College of Surgeons Surgical Risk Calculator (ACS Calculator) are suboptimal for evaluating older adults.
Objective
To evaluate and compare the performance of the ACS Calculator for predicting risk of serious postoperative complications, with the addition of self-reported physical function versus a frailty score.
Design
Prospective cohort.
Setting
Two tertiary care academic medical centers in Massachusetts.
Participants
403 patients age 65+ with serious complication risk of ≥ 5%
Measurements
(1) Self-reported physical function with Late Life Function and Disability Instrument (LLFDI FUNCTION); (2) Frailty Phenotype (FP) with score ranging from 0 to 5 based on presence of slow gait speed, weak handgrip, exhaustion, weight loss, or low activity.
Main Outcome
Increase in c-statistic and net reclassification improvement (NRI) for LLFDI-FUNCTION vs. FP in addition to the ACS Calculator for predicting an adverse postoperative course (either serious complication, discharge to nursing home, readmission, or death within 30 days of surgery)
Results
Over 30 days, 26% of patients developed an adverse postoperative course. The increase in c-statistic for the ACS Calculator (baseline value 0.645) was slightly higher with LLFDI-FUNCTION vs. FP (0.076 vs. 0.058) with bootstrapped difference in c-statistic of 0.005 (95% CI 0.002–0.007). NRI was also better with LLFDI-FUNCTION.
Conclusion
LLFDI-FUNCTION provided slightly better prediction of postoperative complications than the FP. Further studies are needed to confirm these findings and validate the use of the LLFDI-FUNCTION with the ACS Calculator for preoperative assessments of older adults.
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