Cardiopulmonary Risk Index Does Not Predict Complications After Thoracic Surgery

Melendez, Jose; Carlon, Vittoria Arslan

doi:10.1378/chest.114.1.69

Cited by 56 publications

(26 citation statements)

References 26 publications

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“…Another weakness of prior studies is the lack of validation of the models in independent datasets. 25,26 The NSQIP provided a unique opportunity to develop models on more than 80,000 patients and to validate the models on a separate set of more than 99,000 patients. The models developed in this study performed well in validation testing, maintaining almost all of their explanatory power.…”

Section: Discussionmentioning

confidence: 99%

Multifactorial Risk Index for Predicting Postoperative Respiratory Failure in Men After Major Noncardiac Surgery

Arozullah¹,

Daley²,

Henderson³

et al. 2000

Annals of Surgery

601

386

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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.

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Section: Discussionmentioning

confidence: 99%

Multifactorial Risk Index for Predicting Postoperative Respiratory Failure in Men After Major Noncardiac Surgery

Arozullah¹,

Daley²,

Henderson³

et al. 2000

Annals of Surgery

601

386

View full text Add to dashboard Cite

show abstract

“…Current mortality rates range from 2 to 12% [1,2,3,4,5,6,7,8,9,10, 14, 15]. The incidence of morbidity is more difficult to assess because of the large variability in definitions employed [1,2,3,4,5,6,7,8,9,10], but there is general agreement that complications occur in a large percentage of patients undergoing lobectomy or pneumonectomy. With respect to postoperative pulmonary morbidity, rates as high as 49% have been reported [16].…”

Section: Discussionmentioning

confidence: 99%

“…Though operative mortality rates are currently relatively low, morbidity rates remain high [1,2,3,4,5,6,7,8,9,10]. Complications are mainly of cardiac or respiratory type: myocardial infarction, stroke, pulmonary embolism, severe arrhythmias, pneumonias, sepsis, and lung injury represent the most frequent (and serious) complications of lung resections [1,2,3, 7].…”

Section: Introductionmentioning

confidence: 99%

Predictors of an Appropriate Admission to an ICU after a Major Pulmonary Resection

et al. 2006

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Background: There are no recommendations about admission to an ICU after a major lung resection and there are considerable differences among institutions in this respect. Objectives: To audit the practice of admission to an ICU after a major lung resection and evaluate factors predicting the need for intensive care. Methods: Clinicalrecords of all patients who underwent major pulmonary resections in a 14-month period were reviewed retrospectively. The criteria for postoperative admission to the ICU were: (1) standard pneumonectomy if comorbidity index (CI) >0 and/or ASA score >1, and/or abnormal spirometry or arterial gas analysis; (2) extended pneumonectomy; (3) lobectomy if CI ≧4 and/or ASA ≧3; (4) lobectomy if FEV₁ <60% of predicted; (5) lobectomy if FEV₁ is between 60 and 80% and hypercapnia. Results: Among the 49 patients postoperatively admitted to the surgical ward, only 1 needed late intensive care. Among the 55 patients admitted to the ICU, 25 did not require specific intensive care and were discharged 24 h postoperatively, whereas the remaining 30 patients required specific intensive care. Multivariate analysis identified ASA score, predictive postoperative DL_CO, and predictive postoperative product (PPP) as independent predictors of a need for admission to an ICU. Conclusion: This empirical protocol was useful in identifying patients not likely to need admission to the ICU. ASA score, predictive postoperative DL_CO, and PPP are independent predictors of a need for admission to an ICU.

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“…The bulk of the literature shows that there is a clear correlation between the extent of resection and postoperative morbidity and mortality. Segmental or wedge resections have the lowest and pneumonectomies the highest risk (1,4,(11)(12)(13)(14). In a large series by Loddenkemper comprising 433 patients, the mortality rates after pneumonectomy were 9.4% and after lobectomy 5% (12).…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of an Algorithm for the Functional Assessment of Lung Resection Candidates

Wyser

Stulz

Solèr

et al. 1999

Am J Respir Crit Care Med

152

108

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Patients with impaired pulmonary function are at increased risk for the development of postoperative complications. Recently exercise testing and predicted postoperative (ppo) function have gained increasing importance in the evaluation of lung resection candidates. We prospectively evaluated an algorithm for the preoperative functional evaluation that was developed at our institution. This algorithm incorporated the cardiac history including an electrocardiogram (ECG), and the three parameters FEV 1 , diffusing capacity of the lungs for carbon monoxide (D L CO ), and maximal oxygen uptake ( O 2 max), as well as their respective ppo values (FEV 1 -ppo, D L CO -ppo, and O 2 max-ppo) calculated based on radionuclide perfusion scans. A consecutive group of 137 patients (mean age 62 yr; range 23 to 81; 102 males, 35 females) with clinically resectable lesions underwent assessment according to our algorithm. Five patients were deemed functionally inoperable, 132 passed the algorithm and underwent pulmonary resections with standard thoracotomy: 9 segmental or wedge resections, 85 lobectomies (inclusive 3 bilobectomies), and 38 pneumonectomies. All patients were extubated within 24 h. The mean stay in the ICU was 1.4 ( Ϯ 1.8) d, and the mean hospital stay was 14.6 ( Ϯ 5) d. Postoperative complications (within 30 d) occurred in 15 patients (11%), of whom two died (overall mortality rate 1.5%). In comparison to our previous series this meant a 50% reduction in complications whereas the percentage of inoperable patients remained unchanged (4% now, 5% before). We conclude that adherence to our algorithm resulted in a very low complication rate (morbidity and mortality), and excluded more rigorous patient selection as a bias for the improved results. . V . VPatients with lung cancer who undergo evaluation for lung resection are usually smokers and therefore often have concomitant heart and lung disease. This puts them at increased risk for the development of postoperative complications, including permanent respiratory disability and death. Therefore, the functional assessment of their cardiorespiratory reserves is very important. This assessment has recently undergone major changes; apart from preoperative measurement of pulmonary function (FEV 1 , diffusing capacity of the lungs for carbon monoxide [D L CO ]), exercise testing with the determination of maximal oxygen uptake ( O 2 max) has gained increasing importance. Recently the emphasis has shifted to the prediction of postoperative function (predicted postoperative = ppo). The parameter, most firmly established, is the FEV 1 -ppo, but also D L CO -ppo (1-3), and most recently O 2 max-ppo (3) have been suggested.Despite increasing enthusiasm for exercise testing and split function studies, one has to remember that many patients undergoing lung resections up to pneumonectomy do not need extensive tests for the assessment of their cardiorespiratory reserves. We therefore developed an algorithm for the preoperative functional evaluation (Figure 1) incorporating the cardiac...

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Cardiopulmonary Risk Index Does Not Predict Complications After Thoracic Surgery

Cited by 56 publications

References 26 publications

Multifactorial Risk Index for Predicting Postoperative Respiratory Failure in Men After Major Noncardiac Surgery

Multifactorial Risk Index for Predicting Postoperative Respiratory Failure in Men After Major Noncardiac Surgery

Predictors of an Appropriate Admission to an ICU after a Major Pulmonary Resection

Prospective Evaluation of an Algorithm for the Functional Assessment of Lung Resection Candidates

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