Development and Validation of a Score for Prediction of Postoperative Respiratory Complications

Abstract

REFERENCE 1. Kor DJ, Talmor D. Anesthesiology and the acute respiratory distress syndrome: an ounce of prevention is worth a pound of cure [editorial].

The development and validation of the Score for the Prediction of Postoperative Respiratory Complications (SPORC‐2) to predict the requirement for early postoperative tracheal re‐intubation: a hospital registry study

“…In the development cohort, tracheal re‐intubation was captured based on current procedural terminology codes for tracheal intubation and mechanical ventilation management. The primary outcome variable has been validated previously in the development cohort (see also Supporting Information, Section 1.1) . In the validation cohort, tracheal re‐intubation was captured based on time stamps for post‐procedural tracheal extubation and mechanical ventilation after surgery available from the respiratory therapists’ database.…”

“…A detailed definition of all predictors can be found in the Supporting Information (Section 3.1, Table S1). All five predictors of the previously reported SPORC were considered: ASA physical status ≥ 3; history of chronic pulmonary disease; history of heart failure; emergency surgery; and high‐risk surgical services (vascular surgery; transplant surgery; neurosurgery; thoracic surgery; general surgery; and burn surgery) . Furthermore, we considered surgical complexity as quantified by the procedural severity score .…”

“…To enhance the quality and safety of peri‐operative patient care, the Agency for Healthcare Research and Quality recommends risk assessment for postoperative respiratory failure . We developed previously the Score for Prediction of Postoperative Respiratory Complications (SPORC); this is a widely accepted, simple prediction model for development of PPCs with the primary endpoint of early (within 72 h of surgery) tracheal re‐intubation . The SPORC has been advocated by the Agency for Healthcare Research and Quality and has been implemented in recommendations reflecting state of the art knowledge for pre‐operative patient screening .…”

Implementation of a new strategy to improve the peri‐operative management of neuromuscular blockade and its effects on postoperative pulmonary complications

“…Multivariable logistic regression was used to estimate the effect of the quality improvement initiative on the primary outcome of the incidence of PPCs within seven days of surgery. The multivariable model controlled for a priori selected confounders, which included: sex; age; body mass index (BMI); type of admission (in‐patient/ambulatory); emergency/elective surgery; surgical speciality; ASA physical status; Charlson Comorbidity Index; and Score for Prediction Of Postoperative Respiratory Complications (SPORC) . Intra‐operative data collected included: duration of surgery; dose of vasopressors (equivalent noradrenaline dose in mg.min −1 ); non‐depolarising NMBA dose (multiples of 95% effective dose); duration of hypotension (defined as mean arterial pressure < 55 mmHg); average minimum alveolar concentration (MAC) of inhalation anaesthetics adjusted for age; intra‐operative fluid administered; and transfusion of blood products.…”

The association of postoperative pulmonary complications in 109,360 patients with pressure‐controlled or volume‐controlled ventilation

“…We categorised patients by the mode of ventilation (pressure or volume control) that was used most during an operation. The primary outcome was major pulmonary complications within seven postoperative days, a composite of re‐intubation, pulmonary oedema, pulmonary failure or pneumonia, as defined by the ninth and tenth revisions of the International Classification of Diseases codes and by Current Procedural Terminology codes (see also Supporting Information, Table S1) . We regressed mode of ventilation and the following covariates against the primary outcome: sex; age; body mass index; ASA physical status; chronic pulmonary disease; heart failure; the Charlson Comorbidity Index ; emergency surgery; high‐risk surgery (neurosurgery, general, transplant, thoracic, vascular or burns) ; Score for Pre‐operative Prediction of Obstructive Sleep Apnoea (SPOSA) ; surgical service; duration of surgery; surgical complexity; age‐adjusted minimum alveolar concentration of inhalational anaesthetics; opioid dose in morphine equivalents; neuromuscular blocking drug dose; neostigmine dose; volumes of intra‐operative intravenous fluids and blood products; PEEP; mean S P O 2 / Fi O 2 ratio; pulmonary compliance.…”